The intensity of anticoagulant dosing in hospitalized patients with COVID-19: An observational, comparative effectiveness study.
J Hosp Med
; 18(1): 43-54, 2023 01.
Article
en En
| MEDLINE
| ID: mdl-36345824
ABSTRACT
BACKGROUND:
The question of anticoagulant dosing in hospitalized patients with coronavirus disease-2019 (COVID-19) is unresolved, with randomized trials showing mixed results and heterogeneity of treatment effects for in-hospital death.OBJECTIVE:
To examine the association between the intensity of anticoagulation and clinical outcomes in hospitalized patients with COVID-19. DESIGN, SETTING ANDPARTICIPANTS:
Retrospective cohort study of patients with COVID-19 and respiratory impairment who were hospitalized between 3/1/2020-12/31/2020 in two Kaiser Permanente regions. EXPOSURE AND MAINOUTCOME:
We fit propensity score models using categorical regression to estimate the probability of receiving standard prophylactic, intermediate, or full-dose anticoagulation beginning on the day of admission or on the day of first respiratory deterioration. Exposure was defined by the highest dose on the day of admission or within 24 hours after deterioration. The primary outcome was in-hospital death.RESULTS:
We included 17,130 patients in the day of admission analysis and 4,924 patients who experienced respiratory deterioration. There were no differences in propensity score-adjusted odds of in-hospital death for patients who received either intermediate (odds ratio [OR] 1.00, 95% confidence intervals [CI] 0.89-1.12) or full anticoagulation (OR 1.00, 95% CI 0.85-1.17) compared with standard prophylaxis beginning on the day of admission. Similarly, there were no differences in in-hospital death for either intermediate (OR 1.22, 95% CI 0.82-1.82) or full anticoagulation (OR 1.50, 95% CI 0.90-2.51) compared with standard prophylaxis on the day of deterioration.CONCLUSION:
Results of this real-world, comparative effectiveness study showed no differences in in-hospital death among newly admitted or deteriorating patients with COVID-19 who received intermediate-dose or full anticoagulation compared with standard prophylaxis.
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
COVID-19
Tipo de estudio:
Clinical_trials
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Idioma:
En
Revista:
J Hosp Med
Año:
2023
Tipo del documento:
Article