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Anticoagulation in COVID-19: Effect of Enoxaparin, Heparin, and Apixaban on Mortality.

Anticoagulation in COVID-19: Effect of Enoxaparin, Heparin, and Apixaban on Mortality.

Authors :
Billett HH
Reyes-Gil M
Szymanski J
Ikemura K
Stahl LR
Lo Y
Rahman S
Gonzalez-Lugo JD
Kushnir M
Barouqa M
Golestaneh L
Bellin E
Source :
Thrombosis and haemostasis [Thromb Haemost] 2020 Dec; Vol. 120 (12), pp. 1691-1699. Date of Electronic Publication: 2020 Nov 13.
Publication Year :
2020

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.<br />Objective:  We wanted to investigate whether anticoagulation improves survival in COVID-19 and if this improvement in survival is associated with disease severity.<br />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.<br />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.<br />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.<br />Competing Interests: H.H.B. has received research or advisory funding from Bristol Myers Squibb, Janssen Pharmaceuticals, Bayer, Kedrion Pharmaceuticals, and Alexion Pharmaceuticals. M.K. has received research or advisory funding from Bristol Myers Squibb and Janssen Pharmaceuticals. All other authors declare no competing interests.<br /> (Thieme. All rights reserved.)

Details

Language :
English
ISSN :
2567-689X
Volume :
120
Issue :
12
Database :
MEDLINE
Journal :
Thrombosis and haemostasis
Publication Type :
Academic Journal
Accession number :
33186991
Full Text :
https://doi.org/10.1055/s-0040-1720978