Francesco Santoro1, Ivan J Núñez-Gil2, María C Viana-Llamas3, Charbel Maroun Eid4, Rodolfo Romero5, Inmaculada Fernández Rozas6, Alvaro Aparisi7, Victor Manuel Becerra-Muñoz8, Marcos García Aguado9, Jia Huang10, Ludovica Maltese11, Enrico Cerrato12, Emilio Alfonso-Rodriguez13, Alex Fernando Castro Mejía14, Francisco Marin15, Sergio Raposeiras Roubin16, Martino Pepe17, Victor H Moreno Munguia2, Gisela Feltes18, Jesus Varas Navas19, Bernardo Cortese20, Luis Buzón21, Cristoph Liebetrau22, Raquel Ramos-Martinez23, Antonio Fernandez-Ortiz2, Vicente Estrada2, Natale Daniele Brunetti1. 1. Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy. 2. Hospital Clinico San Carlos, Madrid, Spain. 3. Hospital Universitario Guadalajara, Guadalajara, Spain. 4. Hospital Universitario La Paz Instituto de Investigacion, Hospital Universitario La Paz (IdiPAZ), Madrid, Spain. 5. Hospital Universitario Getafe, Madrid, Spain. 6. Hospital Universitario Severo Ochoa, Leganés, Spain. 7. Hospital Clinico Universitario de Valladolid, Valladolid, Spain. 8. Hospital Clinico Universitario Virgen de la Victoria, Malaga, Spain. 9. Hospital Puerta de Hierro de Majadahonda, Majadahonda, Madrid, Spain. 10. The Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen, China. 11. Sant'Andrea Hospital, Vercelli, Italy. 12. San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli, Italy. 13. Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba. 14. Hospital General del norte de Guayaquil IESS, Los Ceibos, Guayaquil, Ecuador. 15. Hospital de la Arreixaca, Murcia, Spain. 16. University Hospital Alvaro Cunqueiro, Vigo, Spain. 17. University Hospital of Bari, Bari, Italy. 18. Nuestra Señora de América, Madrid, Spain. 19. Hospital Universitario Infanta Sofia, San Sebastian de los Reyes, Madrid, Spain. 20. San Carlo Clinic, Milano, Italy. 21. Hospital Universitario, Burgos, Spain. 22. Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. 23. Hospital General de Albacete, Albacete, Spain.
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.
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 2019patients. 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: Ronald Lg Flumignan; Vinicius T Civile; Jéssica Dantas de Sá Tinôco; Patricia If Pascoal; Libnah L Areias; Charbel F Matar; Britta Tendal; Virginia Fm Trevisani; Álvaro N Atallah; Luis Cu Nakano Journal: Cochrane Database Syst Rev Date: 2022-03-04
Authors: Joanne T deKay; Ivette F Emery; Jonathan Rud; Ashley Eldridge; Christine Lord; David J Gagnon; Teresa L May; Victoria L M Herrera; Nelson Ruiz-Opazo; Richard R Riker; Douglas B Sawyer; Sergey Ryzhov; David B Seder Journal: Sci Rep Date: 2021-11-17 Impact factor: 4.996