tetano
Editor, Senior Moderator
Pharmacoepidemiol Drug Saf
. 2022 Mar 24.
doi: 10.1002/pds.5433. Online ahead of print.
Association between pre-admission anticoagulation and in-hospital death, venous thromboembolism, and major bleeding among hospitalized COVID-19 patients in Japan
Motohiko Adomi[SUP] 1 2 [/SUP], Toshiki Kuno[SUP] 3 [/SUP], Jun Komiyama[SUP] 1 2 [/SUP], Yuta Taniguchi[SUP] 1 2 [/SUP], Toshikazu Abe[SUP] 4 5 [/SUP], Atsushi Miyawaki[SUP] 4 6 [/SUP], Shinobu Imai[SUP] 7 [/SUP], Kojiro Morita[SUP] 8 [/SUP], Makoto Saito[SUP] 9 [/SUP], Hiroyuki Ohbe[SUP] 10 [/SUP], Tadashi Kamio[SUP] 11 [/SUP], Nanako Tamiya[SUP] 2 4 [/SUP], Masao Iwagami[SUP] 2 4 [/SUP]
Affiliations
Abstract
Purpose: The coagulation activation leads to thrombotic complications such as venous thromboembolism (VTE) in patients with coronavirus disease-2019 (COVID-19). Prophylactic anticoagulation therapy has been recommended for hospitalized COVID-19 patients in clinical guidelines. This retrospective cohort study aimed to examine the association between pre-admission anticoagulation treatment and three outcomes: in-hospital death, VTE, and major bleeding among hospitalized COVID-19 patients in Japan.
Methods: Using a large-scale claims database built by the Medical Data Vision Co. in Japan, we identified patients hospitalized for COVID-19 who had outpatient prescription data at least once within three months before being hospitalized. Exposure was set as pre-admission anticoagulation treatment (direct oral anticoagulant or vitamin K antagonist), and outcomes were in-hospital death, VTE, and major bleeding. We conducted multivariable logistic regression analyses, adjusting for a single summarized score (a propensity score of receiving pre-admission anticoagulation) for VTE and major bleeding, due to the small number of outcomes.
Results: Among the 2,612 analytic patients, 179 (6.9%) had pre-admission anticoagulation. Crude incidence proportions were 13.4% vs. 8.5% for in-hospital death, 0.56% vs. 0.58% for VTE, and 2.2% vs. 1.1% for major bleeding among patients with and without pre-admission anticoagulation, respectively. Adjusted odds ratios (95% confidence intervals) were 1.25 (0.75-2.08) for in-hospital death, 0.21 (0.02-1.97) for VTE, and 2.63 (0.80-8.65) for major bleeding. Several sensitivity analyses did not change the results.
Conclusions: We found no evidence that pre-admission anticoagulation treatment was associated with in-hospital death. However, a larger sample size may be needed to conclude its effect on VTE and major bleeding. This article is protected by copyright. All rights reserved.
Keywords: Administrative Claims; Anticoagulants; COVID-19; Hemorrhage; Venous Thromboembolism.
. 2022 Mar 24.
doi: 10.1002/pds.5433. Online ahead of print.
Association between pre-admission anticoagulation and in-hospital death, venous thromboembolism, and major bleeding among hospitalized COVID-19 patients in Japan
Motohiko Adomi[SUP] 1 2 [/SUP], Toshiki Kuno[SUP] 3 [/SUP], Jun Komiyama[SUP] 1 2 [/SUP], Yuta Taniguchi[SUP] 1 2 [/SUP], Toshikazu Abe[SUP] 4 5 [/SUP], Atsushi Miyawaki[SUP] 4 6 [/SUP], Shinobu Imai[SUP] 7 [/SUP], Kojiro Morita[SUP] 8 [/SUP], Makoto Saito[SUP] 9 [/SUP], Hiroyuki Ohbe[SUP] 10 [/SUP], Tadashi Kamio[SUP] 11 [/SUP], Nanako Tamiya[SUP] 2 4 [/SUP], Masao Iwagami[SUP] 2 4 [/SUP]
Affiliations
- PMID: 35324035
- DOI: 10.1002/pds.5433
Abstract
Purpose: The coagulation activation leads to thrombotic complications such as venous thromboembolism (VTE) in patients with coronavirus disease-2019 (COVID-19). Prophylactic anticoagulation therapy has been recommended for hospitalized COVID-19 patients in clinical guidelines. This retrospective cohort study aimed to examine the association between pre-admission anticoagulation treatment and three outcomes: in-hospital death, VTE, and major bleeding among hospitalized COVID-19 patients in Japan.
Methods: Using a large-scale claims database built by the Medical Data Vision Co. in Japan, we identified patients hospitalized for COVID-19 who had outpatient prescription data at least once within three months before being hospitalized. Exposure was set as pre-admission anticoagulation treatment (direct oral anticoagulant or vitamin K antagonist), and outcomes were in-hospital death, VTE, and major bleeding. We conducted multivariable logistic regression analyses, adjusting for a single summarized score (a propensity score of receiving pre-admission anticoagulation) for VTE and major bleeding, due to the small number of outcomes.
Results: Among the 2,612 analytic patients, 179 (6.9%) had pre-admission anticoagulation. Crude incidence proportions were 13.4% vs. 8.5% for in-hospital death, 0.56% vs. 0.58% for VTE, and 2.2% vs. 1.1% for major bleeding among patients with and without pre-admission anticoagulation, respectively. Adjusted odds ratios (95% confidence intervals) were 1.25 (0.75-2.08) for in-hospital death, 0.21 (0.02-1.97) for VTE, and 2.63 (0.80-8.65) for major bleeding. Several sensitivity analyses did not change the results.
Conclusions: We found no evidence that pre-admission anticoagulation treatment was associated with in-hospital death. However, a larger sample size may be needed to conclude its effect on VTE and major bleeding. This article is protected by copyright. All rights reserved.
Keywords: Administrative Claims; Anticoagulants; COVID-19; Hemorrhage; Venous Thromboembolism.