Tremblay and colleagues asked whether patients receiving either routine anticoagulation or antiplatelet therapy for existing conditions prior to becoming ill with COVID-19 have different outcomes from patients receiving neither therapy. After matching for existing comorbidities, this retrospective observational study finds no evidence for an effect of prediagnosis anticoagulation on mortality.

Background Coronavirus disease 2019 (COVID‐19) is a global pandemic and information on risk factors for worse prognosis is needed to accurately identify patients at risk and potentially provide insight into therapeutic options. Methods In this retrospective cohort study, including 3703 patients with laboratory confirmed COVID‐19, we identified risk factors associated with all‐cause mortality, need for hospitalization and mechanical ventilation. Results Male gender was independently associated with increased risk of hospitalization (Adjusted Odds Ratio (OR adj : 1.62 (95% Confidence Interval (95% CI): 1.38‐ 1.91)), mechanical ventilation (OR adj : 1.35 (95% CI: 1.08‐ 1.69)) and death (OR adj : 1.46 (95% CI: 1.17‐ 1.82)). Patients > 60 years had higher risk of hospitalization (OR adj : 5.47 (95% CI: 4.29‐ 6.96)), mechanical ventilation (OR adj : 3.26 (95% CI: 2.08‐ 5.11)) and death (OR adj : 13.04 (95% CI: 6.25‐ 27.24)). Congestive heart failure (OR adj : 1.47 (95% CI: 1.06‐ 2.02)) and dementia (OR adj : 2.03 (95% CI: 1.46‐ 2.83)) were associated with increased odds of death, as well as the presence of more than two comorbidities (OR adj : 1.90 (95% CI: 1.35‐ 2.68)). Conclusion COVID‐19 patients of older age, male gender or having more than two comorbidities are at higher risk of hospitalization, mechanical ventilation and death, and should therefore be closely monitored. This article is protected by copyright. All rights reserved.

Observational data suggest an acquired prothrombotic state may contribute to the pathophysiology of COVID-19. These data include elevated D-dimers observed among many COVID-19 patients. We present a retrospective analysis of admission D-dimer, and D-dimer trends, among 1065 adult hospitalized COVID-19 patients, across 6 New York Hospitals. The primary outcome was all-cause mortality. Secondary outcomes were intubation and venous thromboembolism (VTE). Three-hundred-thirteen patients (29.4%) died, 319 (30.0%) required intubation, and 30 (2.8%) had diagnosed VTE. Using Cox proportional-hazard modeling, each 1 μg/ml increase in admission D-dimer level was associated with a hazard ratio (HR) of 1.06 (95%CI 1.04–1.08, p < 0.0001) for death, 1.08 (95%CI 1.06–1.10, p < 0.0001) for intubation, and 1.08 (95%CI 1.03–1.13, p = 0.0087) for VTE. Time-dependent receiver-operator-curves for admission D-dimer as a predictor of death, intubation, and VTE yielded areas-under-the-curve of 0.694, 0.621, and 0.565 respectively. Joint-latent-class-modeling identified distinct groups of patients with respect to D-dimer trend. Patients with stable D-dimer trajectories had HRs of 0.29 (95%CI 0.17–0.49, p < 0.0001) and 0.22 (95%CI 0.10–0.45, p = 0.0001) relative to those with increasing D-dimer trajectories, for the outcomes death and intubation respectively. Patients with low-increasing D-dimer trajectories had a multivariable HR for VTE of 0.18 (95%CI 0.05–0.68, p = 0.0117) relative to those with high-decreasing D-dimer trajectories. Time-dependent receiver-operator-curves for D-dimer trend as a predictor of death, intubation, and VTE yielded areas-under-the-curve of 0.678, 0.699, and 0.722 respectively. Although admission D-dimer levels, and D-dimer trends, are associated with outcomes in COVID-19, they have limited performance characteristics as prognostic tests.

Given the higher likelihood of ACS and respiratory complications amongst SCD patients during the H1N1 outbreak, it is possible that SCD patients are also at higher risk of such complications from COVID-19, particularly those with a history of pulmonary comorbidities. However, it is unclear if the SARS-CoV-2 pandemic will lead to increased rates of ACS for sickle cell patients. Still, hospitalized sickle cell patients should be monitored closely for development of ACS and if this occurs, exchange transfusion should be promptly initiated.