National Trends in Anticoagulation Therapy for COVID-19 Hospitalized Adults in the United States: Analyses of the National COVID Cohort Collaborative.
National Trends in Anticoagulation Therapy for COVID-19 Hospitalized Adults in the United States: Analyses of the National COVID Cohort Collaborative.
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美国 COVID-19 住院成人抗凝治疗的全国趋势：全国 COVID 队列协作分析。
DOI：
10.1093/infdis/jiad194
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
N3CConsortium
中科院分区：
文献类型：
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作者：
Lee,Eileen;Bates,Benjamin;Kuhrt,Nathaniel;Andersen,KathleenM;Visaria,Aayush;Patel,Rachel;Setoguchi,Soko;N3CConsortium
背景2019年住院冠状病毒病患者的抗凝（AC）使用模式及其预测因素（COVID-19）患者尚未得到很好的描述。方法使用国家COVID队列协作，我们进行了一项回顾性队列研究，（2020-2022年）评估AC使用模式并采用修改的Poisson回归确定与治疗性AC相关的因素。结果在162 842名住院COVID-19例患者，64%接受AC，24%接受治疗性AC。治疗性AC使用从2020年的32%下降至2022年的12%，尤其是在2021年12月之后。治疗性AC预测因素包括年龄（相对风险[RR]，1.02; 95%置信区间[CI]，每年1.02-1.02），男性（RR，1.29; 95% CI，1.27-1.32），非西班牙裔黑人（RR，1.16; 95% CI，1.13-1.18），肥胖（RR，1.48; 95% CI，1.43-1.52），住院时间延长（RR，1.01; 95% CI，1.01-1.01每天）和有创通气（RR，1.64; 95% CI，1.59-1.69）。疫苗接种（RR，0.88; 95%CI，84-.92）和较高的Charlson合并症指数（CCI）（RR，0.98; 95%CI，0.97 - 0.98）与较低的治疗AC相关。结论总体而言，三分之二的住院COVID-19患者接受了任何AC，四分之一接受了治疗剂量。治疗性AC在引入Omicron变体后下降。治疗性AC的预测因素包括人口统计学、肥胖、住院时间、有创通气、CCI和疫苗接种，表明AC决策由临床因素驱动，包括COVID-19严重程度、出血风险和合并症。
BackgroundAnticoagulation (AC) utilization patterns and their predictors among hospitalized coronavirus disease 2019 (COVID-19) patients have not been well described.MethodsUsing the National COVID Cohort Collaborative, we conducted a retrospective cohort study (2020–2022) to assess AC use patterns and identify factors associated with therapeutic AC employing modified Poisson regression.ResultsAmong 162 842 hospitalized COVID-19 patients, 64% received AC and 24% received therapeutic AC. Therapeutic AC use declined from 32% in 2020 to 12% in 2022, especially after December 2021. Therapeutic AC predictors included age (relative risk [RR], 1.02; 95% confidence interval [CI], 1.02–1.02 per year), male (RR, 1.29; 95% CI, 1.27–1.32), non-Hispanic black (RR, 1.16; 95% CI, 1.13–1.18), obesity (RR, 1.48; 95% CI, 1.43–1.52), increased length of stay (RR, 1.01; 95% CI, 1.01–1.01 per day), and invasive ventilation (RR, 1.64; 95% CI, 1.59–1.69). Vaccination (RR, 0.88; 95% CI, 84–.92) and higher Charlson Comorbidity Index (CCI) (RR, 0.98; 95% CI, .97–.98) were associated with lower therapeutic AC.ConclusionsOverall, two-thirds of hospitalized COVID-19 patients received any AC and a quarter received therapeutic dosing. Therapeutic AC declined after introduction of the Omicron variant. Predictors of therapeutic AC included demographics, obesity, length of stay, invasive ventilation, CCI, and vaccination, suggesting AC decisions driven by clinical factors including COVID-19 severity, bleeding risks, and comorbidities.