EXPLORE!

Early prophylactic VTE anticoagulation reduces mortality in Covid-19 patients

  2254 Views

eMediNexus    18 June 2021

Hospitalized patients with Covid-19 who are administered prophylactic anticoagulation have lower mortality, according to a new study published online June 11, 2021 in JAMA Network Open.

The multicenter study was conducted across 30 hospitals in Michigan, USA and involved a total of 1351 patients with Covid-19 hospitalized between March 7, 2020, and June 17, 2020. It examined the effect of nonadherence and anticoagulation strategies on in-hospital and 60-day mortality. Out of the 1351 patients, only 18 patients had been diagnosed with venous thromboembolism (VTE), while 219 patients were given treatment-dose anticoagulation.

Patients were categorized into 3 groups: 

  • treatment-dose anticoagulation, defined as ever having received treatment-dose anticoagulation (for prophylactic intent) while hospitalized 
  • prophylactic-dose anticoagulation, defined as only receiving prophylactic-dose anticoagulation while hospitalized 
  • no anticoagulation, defined as receiving neither treatment nor prophylactic anticoagulation while hospitalized 

Key findings of the study

  • Of 1127 patients who ever received anticoagulation, 392 (34.8%) missed ≥2 days of prophylaxis. 
  • Missed prophylaxis varied from 11% to 61% across hospitals and decreased markedly over time (aOR, 0.89; 95% CI, 0.82-0.97 per week). 
  • Non-adherence (missed prophylaxis) was linked with higher 60-day mortality (adjusted hazard ratio [aHR], 1.31; 95% CI, 1.03-1.67) but not in-hospital mortality (aHR, 0.97; 95% CI, 0.91-1.03).
  • Compared to no anticoagulation treatment, receiving any dose of anticoagulation (vs no anticoagulation) was found to reduce in-hospital mortality (only prophylactic dose: aHR, 0.36; 95% CI, 0.26-0.52; any treatment dose: aHR, 0.38; 95% CI, 0.25-0.58). But reduced mortality at the end of 60 days was evident only with the prophylactic dose of anticoagulation (prophylactic dose: aHR, 0.71; 95% CI, 0.51-0.90; treatment dose: aHR, 0.92; 95% CI, 0.63-1.35).

These findings support the early use of prophylactic anticoagulation in patients who are hospitalized with Covid-19, despite lack of further details such as which anticoagulant to choose, what should be the optimum dose and for how long it should be administered. 

In the early days of the pandemic, anticoagulation was not much used but with passage of time and better understanding of the disease, it is now known that prophylaxis for VTE is critical in hospitalized patients with COVID-19 and has become the standard of care in patients with Covid-19.

(Source: Vaughn VM, et al. Trends in venous thromboembolism anticoagulation in patients hospitalized with COVID-19 JAMA Netw Open. 2021 Jun 1;4(6):e2111788; Prophylactic anticoagulation tied to lower death rate in COVID - Medscape - Jun 15, 2021)

 

To comment on this article,
create a free account.

Sign Up to instantly get access to 10000+ Articles & 1000+ Cases

Already registered?

Login Now

Most Popular Articles

News and Updates

eMediNexus provides latest updates on medical news, medical case studies from India. In-depth medical case studies and research designed for doctors and healthcare professionals.