Corresponding author Valentin Fuster (Mount Sinai Heart, New York, USA) and colleagues report in the Journal of the American College of Cardiology that hospitalised COVID-19 patients treated with anticoagulants had improved outcomes both in and out of the intensive care unit setting. They add their work outlines an important therapeutic pathway for COVID-19 patients.
Recent research (from the Icahn School of Medicine, Mount Sinai, New York, USA) indicated that large numbers of patients hospitalised with COVID-19 develop high levels of blood clots, leading to potentially deadly thromboembolic events.
In their study, Fuster et al evaluated records of 2,773 confirmed COVID-19-positive patients admitted to five hospitals in the Mount Sinai Health System in New York City (USA) between 14 March and 11 April 2020. They specifically looked at survival rates for patients placed on anticoagulation versus those not placed on anticoagulation. The authors took certain risk factors into account before evaluating the effectiveness of anticoagulation, including age, ethnicity, pre-existing conditions, and those already on anticoagulants.
Of the COVID-19 patients analysed, 786 (28%) received a full-treatment dose of anticoagulants—a higher dose than what is typically given for blood clot prevention, and one that is usually given to those who already have clots or are suspected to have clots. Treatment with anticoagulants was associated with improved hospital survival among COVID-19 patients both in and out of the intensive care unit setting. Of the patients who did not survive, those on anticoagulants died after spending an average of 21 days in the hospital, compared to the non- anticoagulant patients who died after an average of 14 days in the hospital. The effect of anticoagulation had a more pronounced effect on ventilated patients—62.7% of intubated patients who were not treated with anticoagulants died, compared to 29.1% for intubated patients treated with anticoagulants. Of the intubated patients who did not survive, those with no anticoagulants died after nine days, while those on anticoagulants died after 21 days.
All patients in the study had blood work done when they arrived at the hospital, which included measuring various inflammatory markers. The analysis of their records showed patients who received anticoagulants had higher inflammatory markers compared to patients not treated with anticoagulants. This may suggest patients with more severe illness may benefit from anticoagulants early on.
The observational study also explored the association of systemic anticoagulant treatment with bleeding events. Among those who did not receive anticoagulants, 38 (1.9%) patients had bleeding events, compared to 24 (3%) among those who received anticoagulants, p=0.2).
Fuster comments: “This research demonstrates anticoagulants taken orally, subcutaneously, or intravenously may play a major role in caring for COVID-19 patients, and these may prevent possible deadly events associated with coronavirus, including heart attack, stroke, and pulmonary embolism. Using anticoagulants should be considered when patients get admitted to the emergency room and have tested positive for COVID-19 to possibly improve outcomes. However, each case should be evaluated an individualised basis to account for potential bleeding risk.”
Senior author Girish Nadkarni (Mount Sinai COVID Informatics Center) comments: “This study is opening the door for a more extensive study that will be carried out with 5,000 COVID-19-positive patients, where we will evaluate the effectiveness of three types of antithrombotic therapy—oral antithrombotic, subcutaneous heparin, and intravenous heparin—and then perhaps engage our data for prospective clinical trial. We are excited about these preliminary results that may have a positive impact on COVID-19 patients and potentially give them a greater chance of survival, although more studies are needed.”