Anticoagulation Therapy in Patients With Coronavirus Disease 2019: Results From a Multicenter International Prospective Registry (Health Outcome Predictive Evaluation for Corona Virus Disease 2019 [HOPE-COVID19]).

Abstract

OBJECTIVES:

No standard therapy, including anticoagulation regimens, is currently recommended for coronavirus disease 2019. Aim of this study was to evaluate the efficacy of anticoagulation in coronavirus disease 2019 hospitalized patients and its impact on survival.

DESIGN:

Multicenter international prospective registry (Health Outcome Predictive Evaluation for Corona Virus Disease 2019).

SETTING:

Hospitalized patients with coronavirus disease 2019.

PATIENTS:

Five thousand eight hundred thirty-eight consecutive coronavirus disease 2019 patients.

INTERVENTIONS:

Anticoagulation therapy, including prophylactic and therapeutic regimens, was obtained for each patient.

MEASUREMENTS AND MAIN RESULTS:

Five thousand four hundred eighty patients (94%) did not receive any anticoagulation before hospitalization. Two-thousand six-hundred one patients (44%) during hospitalization received anticoagulation therapy and it was not associated with better survival rate (81% vs 81%; p = 0.94) but with higher risk of bleeding (2.7% vs 1.8%; p = 0.03). Among patients admitted with respiratory failure (49%, n = 2,859, including 391 and 583 patients requiring invasive and noninvasive ventilation, respectively), anticoagulation started during hospitalization was associated with lower mortality rates (32% vs 42%; p < 0.01) and nonsignificant higher risk of bleeding (3.4% vs 2.7%; p = 0.3). Anticoagulation therapy was associated with lower mortality rates in patients treated with invasive ventilation (53% vs 64%; p = 0.05) without increased rates of bleeding (9% vs 8%; p = 0.88) but not in those with noninvasive ventilation (35% vs 38%; p = 0.40). At multivariate Cox' analysis mortality relative risk with anticoagulation was 0.58 (95% CI, 0.49-0.67) in patients admitted with respiratory failure, 0.50 (95% CI, 0.49-0.67) in those requiring invasive ventilation, 0.72 (95% CI, 0.51-1.01) in noninvasive ventilation.

CONCLUSIONS:

Anticoagulation therapy in general population with coronavirus disease 2019 was not associated with better survival rates but with higher bleeding risk. Better results were observed in patients admitted with respiratory failure and requiring invasive ventilation.

• Authors: Francesco Santoro, Ivan J Núñez-Gil, María C Viana-Llamas, Charbel Maroun Eid, Rodolfo Romero, Inmaculada Fernández Rozas, Alvaro Aparisi, Victor Manuel Becerra-Muñoz, Marcos García Aguado, Jia Huang, Ludovica Maltese, Enrico Cerrato, Emilio Alfonso-Rodriguez, Alex Fernando Castro Mejía, Francisco Marin, Sergio Raposeiras Roubin, Martino Pepe, Victor H Moreno Munguia, Gisela Feltes, Jesus Varas Navas, Bernardo Cortese, Luis Buzón, Cristoph Liebetrau, Raquel Ramos-Martinez, Antonio Fernandez-Ortiz, Vicente Estrada, Natale Daniele Brunetti
• Journal: Critical care medicine (Crit Care Med) Vol. 49 Issue 6 Pg. e624-e633 (06 01 2021) ISSN: 1530-0293 [Electronic] United States
• PMID: 33861553 (Publication Type: Comparative Study, Journal Article, Multicenter Study)
• Copyright: Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Chemical References

• Anticoagulants

Topics

• Anticoagulants (therapeutic use)
• COVID-19 (mortality)
• Case-Control Studies
• Correlation of Data
• Cross-Cultural Comparison
• Hemorrhage (chemically induced, mortality)
• Hospitalization
• Humans
• Multicenter Studies as Topic
• Outcome Assessment, Health Care
• Prospective Studies
• Registries
• Respiration, Artificial
• Respiratory Insufficiency (drug therapy, mortality)
• Risk
• Survival Rate
• Treatment Outcome
• COVID-19 Drug Treatment