tetano
Editor, Senior Moderator
J Cardiovasc Med (Hagerstown)
. 2021 Dec 3.
doi: 10.2459/JCM.0000000000001284. Online ahead of print.
Pre- and in-hospital anticoagulation therapy in coronavirus disease 2019 patients: a propensity-matched analysis of in-hospital outcomes
Ilaria Battistoni[SUP] 1 [/SUP], Matteo Francioni, Nuccia Morici, Andrea Rubboli, Gian Marco Podda, Andrea Pappalardo, Mohamed E A Abdelrahim, Osama S El Gendy, Ahmed M Khalaf, Ahmed Abdel M Hamied, Héctor Hernández Garcés, Omar E S Abdelhamid, Karim A M Tawfik, Anna Zeduri, Gabriele Bassi, Giulia Pongetti, Luca Angelini, Stefano Giovinazzo, Pablo Martinez Garcia, Francesco Saverio Serino, Giorgio Emanuele Polistina, Giuseppe Fiorentino, Giovanni Barbati, Anna Toniolo, Azzurra Fabbrizioli, Alberto Belenguer-Muncharaz, Italo Porto, Sibel Ocak, Pietro Minuz, Francisco Bernal, Irina Hermosilla, Josip A Borovac
Affiliations
Abstract
Aims: To estimate if chronic anticoagulant (CAC) treatment is associated with morbidity and mortality outcomes of patients hospitalized for SARS-CoV-2 infection.
Methods: In this European multicentric cohort study, we included 1186 patients of whom 144 were on CAC (12.1%) with positive coronavirus disease 2019 testing between 1 February and 30 July 2020. The average treatment effect (ATE) analysis with a propensity score-matching (PSM) algorithm was used to estimate the impact of CAC on the primary outcomes defined as in-hospital death, major and minor bleeding events, cardiovascular complications (CCI), and acute kidney injury (AKI). We also investigated if different dosages of in-hospital heparin were associated with in-hospital survival.
Results: In unadjusted populations, primary outcomes were significantly higher among CAC patients compared with non-CAC patients: all-cause death (35% vs. 18% P < 0.001), major and minor bleeding (14% vs. 8% P = 0.026; 25% vs. 17% P = 0.014), CCI (27% vs. 14% P < 0.001), and AKI (42% vs. 19% P < 0.001). In ATE analysis with PSM, there was no significant association between CAC and primary outcomes except for an increased incidence of AKI (ATE +10.2%, 95% confidence interval 0.3-20.1%, P = 0.044). Conversely, in-hospital heparin, regardless of dose, was associated with a significantly higher survival compared with no anticoagulation.
Conclusions: The use of CAC was not associated with the primary outcomes except for the increase in AKI. However, in the adjusted survival analysis, any dose of in-hospital anticoagulation was associated with significantly higher survival compared with no anticoagulation.
. 2021 Dec 3.
doi: 10.2459/JCM.0000000000001284. Online ahead of print.
Pre- and in-hospital anticoagulation therapy in coronavirus disease 2019 patients: a propensity-matched analysis of in-hospital outcomes
Ilaria Battistoni[SUP] 1 [/SUP], Matteo Francioni, Nuccia Morici, Andrea Rubboli, Gian Marco Podda, Andrea Pappalardo, Mohamed E A Abdelrahim, Osama S El Gendy, Ahmed M Khalaf, Ahmed Abdel M Hamied, Héctor Hernández Garcés, Omar E S Abdelhamid, Karim A M Tawfik, Anna Zeduri, Gabriele Bassi, Giulia Pongetti, Luca Angelini, Stefano Giovinazzo, Pablo Martinez Garcia, Francesco Saverio Serino, Giorgio Emanuele Polistina, Giuseppe Fiorentino, Giovanni Barbati, Anna Toniolo, Azzurra Fabbrizioli, Alberto Belenguer-Muncharaz, Italo Porto, Sibel Ocak, Pietro Minuz, Francisco Bernal, Irina Hermosilla, Josip A Borovac
Affiliations
- PMID: 34878430
- DOI: 10.2459/JCM.0000000000001284
Abstract
Aims: To estimate if chronic anticoagulant (CAC) treatment is associated with morbidity and mortality outcomes of patients hospitalized for SARS-CoV-2 infection.
Methods: In this European multicentric cohort study, we included 1186 patients of whom 144 were on CAC (12.1%) with positive coronavirus disease 2019 testing between 1 February and 30 July 2020. The average treatment effect (ATE) analysis with a propensity score-matching (PSM) algorithm was used to estimate the impact of CAC on the primary outcomes defined as in-hospital death, major and minor bleeding events, cardiovascular complications (CCI), and acute kidney injury (AKI). We also investigated if different dosages of in-hospital heparin were associated with in-hospital survival.
Results: In unadjusted populations, primary outcomes were significantly higher among CAC patients compared with non-CAC patients: all-cause death (35% vs. 18% P < 0.001), major and minor bleeding (14% vs. 8% P = 0.026; 25% vs. 17% P = 0.014), CCI (27% vs. 14% P < 0.001), and AKI (42% vs. 19% P < 0.001). In ATE analysis with PSM, there was no significant association between CAC and primary outcomes except for an increased incidence of AKI (ATE +10.2%, 95% confidence interval 0.3-20.1%, P = 0.044). Conversely, in-hospital heparin, regardless of dose, was associated with a significantly higher survival compared with no anticoagulation.
Conclusions: The use of CAC was not associated with the primary outcomes except for the increase in AKI. However, in the adjusted survival analysis, any dose of in-hospital anticoagulation was associated with significantly higher survival compared with no anticoagulation.