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

TitleAnticoagulation in COVID-19: Effect of Enoxaparin, Heparin, and Apixaban on Mortality.
Publication TypeJournal Article
Year of Publication2020
AuthorsBillett 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
JournalThromb Haemost
Volume120
Issue12
Pagination1691-1699
Date Published2020 Dec
ISSN2567-689X
KeywordsAged, Aged, 80 and over, Anticoagulants, Biomarkers, Blood Coagulation, Cohort Studies, COVID-19, COVID-19 Drug Treatment, Enoxaparin, Female, Fibrin Fibrinogen Degradation Products, Heparin, Humans, Male, Middle Aged, Pyrazoles, Pyridones, SARS-CoV-2, Survival Analysis
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.

OBJECTIVE:  We wanted to investigate whether anticoagulation improves survival in COVID-19 and if this improvement in survival is associated with disease severity.

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.

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.

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.

DOI10.1055/s-0040-1720978
Alternate JournalThromb Haemost
PubMed ID33186991
PubMed Central IDPMC7869055
Grant ListUL1 TR002556 / TR / NCATS NIH HHS / United States
Related Faculty: 
Kenji Ikemura, M.D.

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