Author: Meizlish, Matthew L.; Goshua, George; Liu, Yiwen; Fine, Rebecca; Amin, Kejal; Chang, Eric; DeFilippo, Nicholas; Keating, Craig; Liu, Yuxin; Mankbadi, Michael; McManus, Dayna; Wang, Stephen Y.; Price, Christina; Bona, Robert D.; Ochoa Chaar, Cassius Iyad; Chun, Hyung J.; Pine, Alexander B.; Rinder, Henry M.; Siner, Jonathan M.; Neuberg, Donna S.; Owusu, Kent A.; Lee, Alfred Ian
Title: Intermediateâ€dose anticoagulation, aspirin, and inâ€hospital mortality in COVIDâ€19: A propensity scoreâ€matched analysis Cord-id: op8cbg14 Document date: 2021_2_22
ID: op8cbg14
Snippet: Thrombotic complications occur at high rates in hospitalized patients with COVIDâ€19, yet the impact of intensive antithrombotic therapy on mortality is uncertain. We examined inâ€hospital mortality with intermediate†compared to prophylacticâ€dose anticoagulation, and separately with inâ€hospital aspirin compared to no antiplatelet therapy, in a large, retrospective study of 2785 hospitalized adult COVIDâ€19 patients. In this analysis, we established two separate, nested cohorts of patie
Document: Thrombotic complications occur at high rates in hospitalized patients with COVIDâ€19, yet the impact of intensive antithrombotic therapy on mortality is uncertain. We examined inâ€hospital mortality with intermediate†compared to prophylacticâ€dose anticoagulation, and separately with inâ€hospital aspirin compared to no antiplatelet therapy, in a large, retrospective study of 2785 hospitalized adult COVIDâ€19 patients. In this analysis, we established two separate, nested cohorts of patients (a) who received intermediate†or prophylacticâ€dose anticoagulation (“anticoagulation cohortâ€, N = 1624), or (b) who were not on home antiplatelet therapy and received either inâ€hospital aspirin or no antiplatelet therapy (“aspirin cohortâ€, N = 1956). To minimize bias and adjust for confounding factors, we incorporated propensity score matching and multivariable regression utilizing various markers of illness severity and other patientâ€specific covariates, yielding treatment groups with wellâ€balanced covariates in each cohort. The primary outcome was cumulative incidence of inâ€hospital death. Among propensity scoreâ€matched patients in the anticoagulation cohort (N = 382), in a multivariable regression model, intermediate†compared to prophylacticâ€dose anticoagulation was associated with a significantly lower cumulative incidence of inâ€hospital death (hazard ratio 0.518 [0.308–0.872]). Among propensityâ€score matched patients in the aspirin cohort (N = 638), in a multivariable regression model, inâ€hospital aspirin compared to no antiplatelet therapy was associated with a significantly lower cumulative incidence of inâ€hospital death (hazard ratio 0.522 [0.336–0.812]). In this propensity scoreâ€matched, observational study of COVIDâ€19, intermediateâ€dose anticoagulation and aspirin were each associated with a lower cumulative incidence of inâ€hospital death.
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