Healthcare disparities among anticoagulation therapies for severe COVID-19 patients in the multi-site VIRUS registry.
J Med Virol
; 93(7): 4303-4318, 2021 Jul.
Article
em En
| MEDLINE
| ID: mdl-33666246
ABSTRACT
Here we analyze hospitalized andintensive care unit coronavirus disease 2019 (COVID-19) patient outcomes from the international VIRUS registry (https//clinicaltrials.gov/ct2/show/NCT04323787). We find that COVID-19 patients administered unfractionated heparin but not enoxaparin have a higher mortality-rate (390 of 1012 = 39%) compared to patients administered enoxaparin but not unfractionated heparin (270 of 1939 = 14%), presenting a risk ratio of 2.79 (95% confidence interval [CI] [2.42, 3.16]; p = 4.45e-52). This difference persists even after balancing on a number of covariates including demographics, comorbidities, admission diagnoses, and method of oxygenation, with an increased mortality rate on discharge from the hospital of 37% (268 of 733) for unfractionated heparin versus 22% (154 of 711) for enoxaparin, presenting a risk ratio of 1.69 (95% CI [1.42, 2.00]; p = 1.5e-8). In these balanced cohorts, a number of complications occurred at an elevated rate for patients administered unfractionated heparin compared to patients administered enoxaparin, including acute kidney injury, acute cardiac injury, septic shock, and anemia. Furthermore, a higher percentage of Black/African American COVID patients (414 of 1294 [32%]) were noted to receive unfractionated heparin compared to White/Caucasian COVID patients (671 of 2644 [25%]), risk ratio 1.26 (95% CI [1.14, 1.40]; p = 7.5e-5). After balancing upon available clinical covariates, this difference in anticoagulant use remained statistically significant (311 of 1047 [30%] for Black/African American vs. 263 of 1047 [25%] for White/Caucasian, p = .02, risk ratio 1.18; 95% CI [1.03, 1.36]). While retrospective studies cannot suggest any causality, these findings motivate the need for follow-up prospective research into the observed racial disparity in anticoagulant use and outcomes for severe COVID-19 patients.
Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Contexto em Saúde:
1_ASSA2030
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2_ODS3
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4_TD
/
6_ODS3_enfermedades_notrasmisibles
Problema de saúde:
1_acesso_equitativo_servicos
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2_cobertura_universal
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4_covid_19
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4_pneumonia
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6_cardiovascular_diseases
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6_other_respiratory_diseases
Assunto principal:
Trombose
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Heparina
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Enoxaparina
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Disparidades em Assistência à Saúde
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COVID-19
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Anticoagulantes
Tipo de estudo:
Observational_studies
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Risk_factors_studies
Aspecto:
Determinantes_sociais_saude
Limite:
Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Med Virol
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
Estados Unidos