Challenges in evaluating treatments for COVID-19: The case of in-hospital anticoagulant use and the risk of adverse outcomes
Anticoagulants are a potential treatment for the thrombotic complications resulting from COVID-19. We aimed to determine the association between anticoagulant use and adverse outcomes among hospitalized patients with COVID-19. We used data from the COVID-19 International Collaborative Research Proje...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-11-01
|
| Series: | Frontiers in Pharmacology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2022.1034636/full |
| _version_ | 1811216995887087616 |
|---|---|
| author | Ya-Hui Yu Ya-Hui Yu In-Sun Oh In-Sun Oh In-Sun Oh In-Sun Oh Han Eol Jeong Han Eol Jeong Robert W. Platt Robert W. Platt Robert W. Platt Antonios Douros Antonios Douros Antonios Douros Antonios Douros Ju-Young Shin Ju-Young Shin Ju-Young Shin Kristian B. Filion Kristian B. Filion Kristian B. Filion |
| author_facet | Ya-Hui Yu Ya-Hui Yu In-Sun Oh In-Sun Oh In-Sun Oh In-Sun Oh Han Eol Jeong Han Eol Jeong Robert W. Platt Robert W. Platt Robert W. Platt Antonios Douros Antonios Douros Antonios Douros Antonios Douros Ju-Young Shin Ju-Young Shin Ju-Young Shin Kristian B. Filion Kristian B. Filion Kristian B. Filion |
| author_sort | Ya-Hui Yu |
| collection | DOAJ |
| description | Anticoagulants are a potential treatment for the thrombotic complications resulting from COVID-19. We aimed to determine the association between anticoagulant use and adverse outcomes among hospitalized patients with COVID-19. We used data from the COVID-19 International Collaborative Research Project in South Korea from January to June 2020. We defined exposure using an intention-to-treat approach, with person-time classified as use or non-use of anticoagulants at cohort entry, and a time-varying approach. The primary outcome was all-cause, in-hospital mortality; the secondary outcome was a composite including respiratory outcomes, cardiovascular outcomes, venous thromboembolism, major bleeding, and intensive care unit admission. Cox proportional hazards models estimated adjusted hazard ratios (HRs) of the outcomes comparing use versus non-use of anticoagulants. Our cohort included 2,677 hospitalized COVID-19 patients, of whom 24 received anticoagulants at cohort entry. Users were older and had more comorbidities. The crude incidence rate (per 1,000 person-days) of mortality was 5.83 (95% CI: 2.80, 10.72) among anticoagulant users and 1.36 (95% CI: 1.14, 1.59) for non-users. Crude rates of the composite outcome were 3.20 (95% CI: 1.04, 7.47) and 1.80 (95% CI: 1.54, 2.08), respectively. Adjusted HRs for mortality (HR: 1.12, 95% CI: 0.48, 2.64) and the composite outcome (HR: 0.79, 95% CI: 0.28, 2.18) were inconclusive. Although our study was not able to draw conclusions on anticoagulant effectiveness for COVID-19 outcomes, these results can contribute to future knowledge syntheses of this important question. Our study demonstrated that the dynamic pandemic environment may have important implications for observational studies of COVID-19 treatment effectiveness. |
| first_indexed | 2024-04-12T06:46:37Z |
| format | Article |
| id | doaj.art-236e18c76be343eca132237a5a73f8e9 |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-04-12T06:46:37Z |
| publishDate | 2022-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj.art-236e18c76be343eca132237a5a73f8e92022-12-22T03:43:30ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122022-11-011310.3389/fphar.2022.10346361034636Challenges in evaluating treatments for COVID-19: The case of in-hospital anticoagulant use and the risk of adverse outcomesYa-Hui Yu0Ya-Hui Yu1In-Sun Oh2In-Sun Oh3In-Sun Oh4In-Sun Oh5Han Eol Jeong6Han Eol Jeong7Robert W. Platt8Robert W. Platt9Robert W. Platt10Antonios Douros11Antonios Douros12Antonios Douros13Antonios Douros14Ju-Young Shin15Ju-Young Shin16Ju-Young Shin17Kristian B. Filion18Kristian B. Filion19Kristian B. Filion20Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, CanadaCentre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, CanadaDepartment of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, CanadaCentre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, CanadaSchool of Pharmacy Science, Sungkyunkwan University, Suwon, Gyeonggi-do, South KoreaDepartment of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, Gyeonggi-do, South KoreSchool of Pharmacy Science, Sungkyunkwan University, Suwon, Gyeonggi-do, South KoreaDepartment of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, Gyeonggi-do, South KoreDepartment of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, CanadaCentre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, CanadaDepartment of Pediatrics, McGill University, Montreal, QC, CanadaDepartment of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, CanadaCentre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, CanadaDepartment of Medicine, McGill University, Montreal, QC, CanadaInstitute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Berlin, GermanySchool of Pharmacy Science, Sungkyunkwan University, Suwon, Gyeonggi-do, South KoreaDepartment of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, Gyeonggi-do, South KoreDepartment of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Seoul, South KoreaDepartment of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, CanadaCentre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, CanadaDepartment of Medicine, McGill University, Montreal, QC, CanadaAnticoagulants are a potential treatment for the thrombotic complications resulting from COVID-19. We aimed to determine the association between anticoagulant use and adverse outcomes among hospitalized patients with COVID-19. We used data from the COVID-19 International Collaborative Research Project in South Korea from January to June 2020. We defined exposure using an intention-to-treat approach, with person-time classified as use or non-use of anticoagulants at cohort entry, and a time-varying approach. The primary outcome was all-cause, in-hospital mortality; the secondary outcome was a composite including respiratory outcomes, cardiovascular outcomes, venous thromboembolism, major bleeding, and intensive care unit admission. Cox proportional hazards models estimated adjusted hazard ratios (HRs) of the outcomes comparing use versus non-use of anticoagulants. Our cohort included 2,677 hospitalized COVID-19 patients, of whom 24 received anticoagulants at cohort entry. Users were older and had more comorbidities. The crude incidence rate (per 1,000 person-days) of mortality was 5.83 (95% CI: 2.80, 10.72) among anticoagulant users and 1.36 (95% CI: 1.14, 1.59) for non-users. Crude rates of the composite outcome were 3.20 (95% CI: 1.04, 7.47) and 1.80 (95% CI: 1.54, 2.08), respectively. Adjusted HRs for mortality (HR: 1.12, 95% CI: 0.48, 2.64) and the composite outcome (HR: 0.79, 95% CI: 0.28, 2.18) were inconclusive. Although our study was not able to draw conclusions on anticoagulant effectiveness for COVID-19 outcomes, these results can contribute to future knowledge syntheses of this important question. Our study demonstrated that the dynamic pandemic environment may have important implications for observational studies of COVID-19 treatment effectiveness.https://www.frontiersin.org/articles/10.3389/fphar.2022.1034636/fullanticoagulantsCOVID-19mortalitySouth Koreaobservational study |
| spellingShingle | Ya-Hui Yu Ya-Hui Yu In-Sun Oh In-Sun Oh In-Sun Oh In-Sun Oh Han Eol Jeong Han Eol Jeong Robert W. Platt Robert W. Platt Robert W. Platt Antonios Douros Antonios Douros Antonios Douros Antonios Douros Ju-Young Shin Ju-Young Shin Ju-Young Shin Kristian B. Filion Kristian B. Filion Kristian B. Filion Challenges in evaluating treatments for COVID-19: The case of in-hospital anticoagulant use and the risk of adverse outcomes Frontiers in Pharmacology anticoagulants COVID-19 mortality South Korea observational study |
| title | Challenges in evaluating treatments for COVID-19: The case of in-hospital anticoagulant use and the risk of adverse outcomes |
| title_full | Challenges in evaluating treatments for COVID-19: The case of in-hospital anticoagulant use and the risk of adverse outcomes |
| title_fullStr | Challenges in evaluating treatments for COVID-19: The case of in-hospital anticoagulant use and the risk of adverse outcomes |
| title_full_unstemmed | Challenges in evaluating treatments for COVID-19: The case of in-hospital anticoagulant use and the risk of adverse outcomes |
| title_short | Challenges in evaluating treatments for COVID-19: The case of in-hospital anticoagulant use and the risk of adverse outcomes |
| title_sort | challenges in evaluating treatments for covid 19 the case of in hospital anticoagulant use and the risk of adverse outcomes |
| topic | anticoagulants COVID-19 mortality South Korea observational study |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2022.1034636/full |
| work_keys_str_mv | AT yahuiyu challengesinevaluatingtreatmentsforcovid19thecaseofinhospitalanticoagulantuseandtheriskofadverseoutcomes AT yahuiyu challengesinevaluatingtreatmentsforcovid19thecaseofinhospitalanticoagulantuseandtheriskofadverseoutcomes AT insunoh challengesinevaluatingtreatmentsforcovid19thecaseofinhospitalanticoagulantuseandtheriskofadverseoutcomes AT insunoh challengesinevaluatingtreatmentsforcovid19thecaseofinhospitalanticoagulantuseandtheriskofadverseoutcomes AT insunoh challengesinevaluatingtreatmentsforcovid19thecaseofinhospitalanticoagulantuseandtheriskofadverseoutcomes AT insunoh challengesinevaluatingtreatmentsforcovid19thecaseofinhospitalanticoagulantuseandtheriskofadverseoutcomes AT haneoljeong challengesinevaluatingtreatmentsforcovid19thecaseofinhospitalanticoagulantuseandtheriskofadverseoutcomes AT haneoljeong challengesinevaluatingtreatmentsforcovid19thecaseofinhospitalanticoagulantuseandtheriskofadverseoutcomes AT robertwplatt challengesinevaluatingtreatmentsforcovid19thecaseofinhospitalanticoagulantuseandtheriskofadverseoutcomes AT robertwplatt challengesinevaluatingtreatmentsforcovid19thecaseofinhospitalanticoagulantuseandtheriskofadverseoutcomes AT robertwplatt challengesinevaluatingtreatmentsforcovid19thecaseofinhospitalanticoagulantuseandtheriskofadverseoutcomes AT antoniosdouros challengesinevaluatingtreatmentsforcovid19thecaseofinhospitalanticoagulantuseandtheriskofadverseoutcomes AT antoniosdouros challengesinevaluatingtreatmentsforcovid19thecaseofinhospitalanticoagulantuseandtheriskofadverseoutcomes AT antoniosdouros challengesinevaluatingtreatmentsforcovid19thecaseofinhospitalanticoagulantuseandtheriskofadverseoutcomes AT antoniosdouros challengesinevaluatingtreatmentsforcovid19thecaseofinhospitalanticoagulantuseandtheriskofadverseoutcomes AT juyoungshin challengesinevaluatingtreatmentsforcovid19thecaseofinhospitalanticoagulantuseandtheriskofadverseoutcomes AT juyoungshin challengesinevaluatingtreatmentsforcovid19thecaseofinhospitalanticoagulantuseandtheriskofadverseoutcomes AT juyoungshin challengesinevaluatingtreatmentsforcovid19thecaseofinhospitalanticoagulantuseandtheriskofadverseoutcomes AT kristianbfilion challengesinevaluatingtreatmentsforcovid19thecaseofinhospitalanticoagulantuseandtheriskofadverseoutcomes AT kristianbfilion challengesinevaluatingtreatmentsforcovid19thecaseofinhospitalanticoagulantuseandtheriskofadverseoutcomes AT kristianbfilion challengesinevaluatingtreatmentsforcovid19thecaseofinhospitalanticoagulantuseandtheriskofadverseoutcomes |