Intermediate‐dose anticoagulation, aspirin, and in‐hospital mortality in COVID‐19: A propensity score‐matched analysis

Abstract

Thrombotic complications occur at high rates in hospitalized patients with COVID‐19, yet the impact of intensive antithrombotic therapy on mortality is uncertain. We examined in‐hospital mortality with intermediate‐ compared to prophylactic‐dose anticoagulation, and separately with in‐hospital aspirin compared to no antiplatelet therapy, in a large, retrospective study of 2785 hospitalized adult COVID‐19 patients. In this analysis, we established two separate, nested cohorts of patients (a) who received intermediate‐ or prophylactic‐dose anticoagulation (“anticoagulation cohort”, N = 1624), or (b) who were not on home antiplatelet therapy and received either in‐hospital aspirin or no antiplatelet therapy (“aspirin cohort”, N = 1956). To minimize bias and adjust for confounding factors, we incorporated propensity score matching and multivariable regression utilizing various markers of illness severity and other patient‐specific covariates, yielding treatment groups with well‐balanced covariates in each cohort. The primary outcome was cumulative incidence of in‐hospital death. Among propensity score‐matched patients in the anticoagulation cohort (N = 382), in a multivariable regression model, intermediate‐ compared to prophylactic‐dose anticoagulation was associated with a significantly lower cumulative incidence of in‐hospital death (hazard ratio 0.518 [0.308–0.872]). Among propensity‐score matched patients in the aspirin cohort (N = 638), in a multivariable regression model, in‐hospital aspirin compared to no antiplatelet therapy was associated with a significantly lower cumulative incidence of in‐hospital death (hazard ratio 0.522 [0.336–0.812]). In this propensity score‐matched, observational study of COVID‐19, intermediate‐dose anticoagulation and aspirin were each associated with a lower cumulative incidence of in‐hospital death.

Mean Platelet Volume Predicts Severe COVID-19 Illness

“…27 Indirect support to this theory emerges from recent evidence that in-hospital aspirin (81 mg daily) administration in COVID-19 patients has been associated with nearly 50% reduction in the risk of death. 28 In conclusion, the results of our pooled analysis highlight that platelet volume is very frequently increased in COVID-19 patients with severe illness, especially in those at higher risk of dying, such that routine measurement of MPV along with other useful laboratory parameters 29,30 should be considered for identifying those cases at higher risk of adverse progression, needing more assiduous and even more aggressive care.…”

Differences in coagulopathy indices in patients with severe versus non-severe COVID-19: a meta-analysis of 35 studies and 6427 patients

“…Only one of the study included in our analysis investigated the effects of anticoagulation with low molecular weight heparin (LMWH) therapy on survival of Covid-19 patients, demonstrating that the use of anticoagulant therapy resulted in lower mortality in patients with severe coagulopathy with SIC score ≥ 4 (LMWH: 40.0% vs No-LMWH: 64.2%, P = 0.029) or D-dimer > sixfold of upper limit of normal (32.8% vs 52.4%, P = 0.017), but no overall benefit between heparin users and nonusers (30.3% vs 29.7%, P = 0.910) 23 . Moreover, a propensity-score matched retrospective study of 2785 COVID‐19 patients showed a significantly reduced cumulative incidence of in‐hospital death (HR 0.518 [0.308–0.872]) with the use of intermediate‐dose of anticoagulation compared to the only prophylactic‐dose and with the use of aspirin compared to no antiplatelet therapy (HR 0.522 [0.336–0.812]) 57 .…”

Protecting older patients with cardiovascular diseases from COVID-19 complications using current medications

“…In a study including 314 COVID-19 patients, ASA was independently associated with decreased risk of mechanical ventilation, intensive care unit admission, and in-hospital mortality, whereas there were no differences in major bleedings between ASA users and non-users [ 67 ]. A large observational study which included hospitalised COVID-19 patients, reported a significantly lower incidence of in-hospital death in patients who received intermediate—compared to prophylactic-dose anticoagulation, and, separately, in patients who received in-hospital ASA compared to those who received no antiplatelet therapy [ 68 ].Conversely, a recent meta-analysis has investigated the possible association of ASA use in reducing mortality in patients with COVID-19 [ 69 ]. This meta-analysis included only 3 studies with a total of 1,054 patients, mortality rates were not statistically different between ASA users (22.6%) and non-users (18.3%) suggesting no protective effect of ASA in COVID-19 patients.…”