Henny H Billett1, Morayma Reyes-Gil2, James Szymanski2, Kenji Ikemura2, Lindsay R Stahl3, Yungtai Lo4, Shafia Rahman1, Jesus D Gonzalez-Lugo1, Margarita Kushnir1, Mohammad Barouqa2, Ladan Golestaneh5, Eran Bellin4. 1. Division of Hematology, Departments of Oncology and Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States. 2. Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States. 3. Montefiore Information Technology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States. 4. Department of Epidemiology and Population Health and Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States. 5. Division of Nephrology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States.
Abstract
BACKGROUND: Mortality in coronavirus disease of 2019 (COVID-19) is associated with increases in prothrombotic parameters, particularly D-dimer levels. Anticoagulation has been proposed as therapy to decrease mortality, often adjusted for illness severity. OBJECTIVE: We wanted to investigate whether anticoagulation improves survival in COVID-19 and if this improvement in survival is associated with disease severity. METHODS: This is a cohort study simulating an intention-to-treat clinical trial, by analyzing the effect on mortality of anticoagulation therapy chosen in the first 48 hours of hospitalization. We analyzed 3,625 COVID-19+ inpatients, controlling for age, gender, glomerular filtration rate, oxygen saturation, ventilation requirement, intensive care unit admission, and time period, all determined during the first 48 hours. RESULTS: Adjusted logistic regression analyses demonstrated a significant decrease in mortality with prophylactic use of apixaban (odds ratio [OR] 0.46, p = 0.001) and enoxaparin (OR = 0.49, p = 0.001). Therapeutic apixaban was also associated with decreased mortality (OR 0.57, p = 0.006) but was not more beneficial than prophylactic use when analyzed over the entire cohort or within D-dimer stratified categories. Higher D-dimer levels were associated with increased mortality (p < 0.0001). When adjusted for these same comorbidities within D-dimer strata, patients with D-dimer levels < 1 µg/mL did not appear to benefit from anticoagulation while patients with D-dimer levels > 10 µg/mL derived the most benefit. There was no increase in transfusion requirement with any of the anticoagulants used. CONCLUSION: We conclude that COVID-19+ patients with moderate or severe illness benefit from anticoagulation and that apixaban has similar efficacy to enoxaparin in decreasing mortality in this disease. Thieme. All rights reserved.
BACKGROUND:Mortality in coronavirus disease of 2019 (COVID-19) is associated with increases in prothrombotic parameters, particularly D-dimer levels. Anticoagulation has been proposed as therapy to decrease mortality, often adjusted for illness severity. OBJECTIVE: We wanted to investigate whether anticoagulation improves survival in COVID-19 and if this improvement in survival is associated with disease severity. METHODS: This is a cohort study simulating an intention-to-treat clinical trial, by analyzing the effect on mortality of anticoagulation therapy chosen in the first 48 hours of hospitalization. We analyzed 3,625 COVID-19+ inpatients, controlling for age, gender, glomerular filtration rate, oxygen saturation, ventilation requirement, intensive care unit admission, and time period, all determined during the first 48 hours. RESULTS: Adjusted logistic regression analyses demonstrated a significant decrease in mortality with prophylactic use of apixaban (odds ratio [OR] 0.46, p = 0.001) and enoxaparin (OR = 0.49, p = 0.001). Therapeutic apixaban was also associated with decreased mortality (OR 0.57, p = 0.006) but was not more beneficial than prophylactic use when analyzed over the entire cohort or within D-dimer stratified categories. Higher D-dimer levels were associated with increased mortality (p < 0.0001). When adjusted for these same comorbidities within D-dimer strata, patients with D-dimer levels < 1 µg/mL did not appear to benefit from anticoagulation while patients with D-dimer levels > 10 µg/mL derived the most benefit. There was no increase in transfusion requirement with any of the anticoagulants used. CONCLUSION: We conclude that COVID-19+ patients with moderate or severe illness benefit from anticoagulation and that apixaban has similar efficacy to enoxaparin in decreasing mortality in this disease. Thieme. All rights reserved.
Authors: Panagiotis Volteas; Panagiotis Drakos; Leor N Alkadaa; Nathaniel A Cleri; Anthony A Asencio; Anthony Oganov; Stefanos Giannopoulos; Jordan R Saadon; Charles B Mikell; Jerry A Rubano; Nicos Labropoulos; Apostolos K Tassiopoulos; Sima Mofakham; Mohsen Bannazadeh Journal: J Vasc Surg Venous Lymphat Disord Date: 2022-06-15
Authors: Kathleen M Andersen; Corey S Joseph; Hemalkumar B Mehta; Michael B Streiff; Joshua F Betz; Robert C Bollinger; Arielle M Fisher; Amita Gupta; Charles F LeMaistre; Matthew L Robinson; Yanxun Xu; Derek K Ng; G Caleb Alexander; Brian T Garibaldi Journal: Res Pract Thromb Haemost Date: 2022-07-15
Authors: Morayma Reyes Gil; Jesus D Gonzalez-Lugo; Shafia Rahman; Mohammad Barouqa; James Szymanski; Kenji Ikemura; Yungtai Lo; Henny H Billett Journal: Front Physiol Date: 2021-02-23 Impact factor: 4.566
Authors: José Miguel Rivera-Caravaca; Benjamin J R Buckley; Stephanie L Harrison; Elnara Fazio-Eynullayeva; Paula Underhill; Francisco Marín; Gregory Y H Lip Journal: Thromb Res Date: 2021-06-27 Impact factor: 3.944