The effect of anti-coagulation dosage on the outcome of hospitalized COVID-19 patients in Ethiopia: a multi-center retrospective cohort study
Abstract Background Studies have indicated that hospitalized COVID-19 patients benefit from anticoagulation therapy in terms of survival; however, there is an ongoing controversy over the optimum anticoagulant dosage. This study aimed to compare clinical outcomes between patients who received prophy...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-03-01
|
| Series: | BMC Pulmonary Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12890-023-02375-x |
| _version_ | 1797865666047377408 |
|---|---|
| author | Abel Girma Tessema Zekarias Masresha Mengiste Tsegaye Gebreyes Hundie Hailemichael Getachew Yosef Dawit Kebede Huluka Abebaw Bekele Seyoum Hannibal Kassahun Abate Rawleigh Craig Howe |
| author_facet | Abel Girma Tessema Zekarias Masresha Mengiste Tsegaye Gebreyes Hundie Hailemichael Getachew Yosef Dawit Kebede Huluka Abebaw Bekele Seyoum Hannibal Kassahun Abate Rawleigh Craig Howe |
| author_sort | Abel Girma Tessema |
| collection | DOAJ |
| description | Abstract Background Studies have indicated that hospitalized COVID-19 patients benefit from anticoagulation therapy in terms of survival; however, there is an ongoing controversy over the optimum anticoagulant dosage. This study aimed to compare clinical outcomes between patients who received prophylactic anticoagulation and those who received therapeutic anticoagulation. Methods A multi-center retrospective cohort study was conducted to determine the impact of anticoagulation dosage in hospitalized COVID-19 patients in Ethiopia. The primary outcome measure was in-hospital mortality, and it was assessed using multivariable binary logistic regression and covariate-adjusted Cox Proportional Hazard model. For critical and severe COVID-19 patients, subgroup analyses were performed using multivariable binary logistic regression model and multivariable Cox regression models. Result A total of 472 hospitalized COVID-19 patients were included in this study, of whom 235 (49.8%) received therapeutic anticoagulation and 237 (50.2%) received prophylactic dose. The demographic and baseline clinical characteristics were roughly similar between the groups. After adjustment for several confounders, in critical COVID-19 subgroup, therapeutic dose of anticoagulation was significantly associated with a higher inpatient mortality (AOR 2.27, 95% CI, 1.18—4.35, p = 0.013), whereas in severe COVID-19 subgroup, anticoagulation dosage was not associated with inpatient mortality (OR, 1.02, 95% CI, 0.45 – 2.33, p = 0.958). In severe COVID-19 patient group however, the incidence of thrombosis was slightly lower in the therapeutic group as compared with prophylactic group although the difference was not statistically significant (AOR 0.15, 95% CI, 0.02 – 1.20, p = 0.073). Although there were only six major bleeding events in this study, all these were recorded from patients in the therapeutic subgroup, making the difference statistically significant (p = 0.013). Conclusion Although this study is limited by its observational design, our results are not consistent with current recommendations on anti-coagulation dose for hospitalized patients with COVID-19, necessitating the need for RCT in resource limited settings. |
| first_indexed | 2024-04-09T23:11:49Z |
| format | Article |
| id | doaj.art-4854d67200c44922981ba4a81f5f5040 |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-04-09T23:11:49Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-4854d67200c44922981ba4a81f5f50402023-03-22T10:19:07ZengBMCBMC Pulmonary Medicine1471-24662023-03-0123111110.1186/s12890-023-02375-xThe effect of anti-coagulation dosage on the outcome of hospitalized COVID-19 patients in Ethiopia: a multi-center retrospective cohort studyAbel Girma Tessema0Zekarias Masresha Mengiste1Tsegaye Gebreyes Hundie2Hailemichael Getachew Yosef3Dawit Kebede Huluka4Abebaw Bekele Seyoum5Hannibal Kassahun Abate6Rawleigh Craig Howe7Armauer Hansen Research Institute (AHRI)Armauer Hansen Research Institute (AHRI)Eka-Kotebe General HospitalArmauer Hansen Research Institute (AHRI)Addis Ababa UniversityEka-Kotebe General HospitalAddis Ababa UniversityArmauer Hansen Research Institute (AHRI)Abstract Background Studies have indicated that hospitalized COVID-19 patients benefit from anticoagulation therapy in terms of survival; however, there is an ongoing controversy over the optimum anticoagulant dosage. This study aimed to compare clinical outcomes between patients who received prophylactic anticoagulation and those who received therapeutic anticoagulation. Methods A multi-center retrospective cohort study was conducted to determine the impact of anticoagulation dosage in hospitalized COVID-19 patients in Ethiopia. The primary outcome measure was in-hospital mortality, and it was assessed using multivariable binary logistic regression and covariate-adjusted Cox Proportional Hazard model. For critical and severe COVID-19 patients, subgroup analyses were performed using multivariable binary logistic regression model and multivariable Cox regression models. Result A total of 472 hospitalized COVID-19 patients were included in this study, of whom 235 (49.8%) received therapeutic anticoagulation and 237 (50.2%) received prophylactic dose. The demographic and baseline clinical characteristics were roughly similar between the groups. After adjustment for several confounders, in critical COVID-19 subgroup, therapeutic dose of anticoagulation was significantly associated with a higher inpatient mortality (AOR 2.27, 95% CI, 1.18—4.35, p = 0.013), whereas in severe COVID-19 subgroup, anticoagulation dosage was not associated with inpatient mortality (OR, 1.02, 95% CI, 0.45 – 2.33, p = 0.958). In severe COVID-19 patient group however, the incidence of thrombosis was slightly lower in the therapeutic group as compared with prophylactic group although the difference was not statistically significant (AOR 0.15, 95% CI, 0.02 – 1.20, p = 0.073). Although there were only six major bleeding events in this study, all these were recorded from patients in the therapeutic subgroup, making the difference statistically significant (p = 0.013). Conclusion Although this study is limited by its observational design, our results are not consistent with current recommendations on anti-coagulation dose for hospitalized patients with COVID-19, necessitating the need for RCT in resource limited settings.https://doi.org/10.1186/s12890-023-02375-xCOVID-19ThrombosisAnticoagulationHeparinEnoxaparinBleeding |
| spellingShingle | Abel Girma Tessema Zekarias Masresha Mengiste Tsegaye Gebreyes Hundie Hailemichael Getachew Yosef Dawit Kebede Huluka Abebaw Bekele Seyoum Hannibal Kassahun Abate Rawleigh Craig Howe The effect of anti-coagulation dosage on the outcome of hospitalized COVID-19 patients in Ethiopia: a multi-center retrospective cohort study BMC Pulmonary Medicine COVID-19 Thrombosis Anticoagulation Heparin Enoxaparin Bleeding |
| title | The effect of anti-coagulation dosage on the outcome of hospitalized COVID-19 patients in Ethiopia: a multi-center retrospective cohort study |
| title_full | The effect of anti-coagulation dosage on the outcome of hospitalized COVID-19 patients in Ethiopia: a multi-center retrospective cohort study |
| title_fullStr | The effect of anti-coagulation dosage on the outcome of hospitalized COVID-19 patients in Ethiopia: a multi-center retrospective cohort study |
| title_full_unstemmed | The effect of anti-coagulation dosage on the outcome of hospitalized COVID-19 patients in Ethiopia: a multi-center retrospective cohort study |
| title_short | The effect of anti-coagulation dosage on the outcome of hospitalized COVID-19 patients in Ethiopia: a multi-center retrospective cohort study |
| title_sort | effect of anti coagulation dosage on the outcome of hospitalized covid 19 patients in ethiopia a multi center retrospective cohort study |
| topic | COVID-19 Thrombosis Anticoagulation Heparin Enoxaparin Bleeding |
| url | https://doi.org/10.1186/s12890-023-02375-x |
| work_keys_str_mv | AT abelgirmatessema theeffectofanticoagulationdosageontheoutcomeofhospitalizedcovid19patientsinethiopiaamulticenterretrospectivecohortstudy AT zekariasmasreshamengiste theeffectofanticoagulationdosageontheoutcomeofhospitalizedcovid19patientsinethiopiaamulticenterretrospectivecohortstudy AT tsegayegebreyeshundie theeffectofanticoagulationdosageontheoutcomeofhospitalizedcovid19patientsinethiopiaamulticenterretrospectivecohortstudy AT hailemichaelgetachewyosef theeffectofanticoagulationdosageontheoutcomeofhospitalizedcovid19patientsinethiopiaamulticenterretrospectivecohortstudy AT dawitkebedehuluka theeffectofanticoagulationdosageontheoutcomeofhospitalizedcovid19patientsinethiopiaamulticenterretrospectivecohortstudy AT abebawbekeleseyoum theeffectofanticoagulationdosageontheoutcomeofhospitalizedcovid19patientsinethiopiaamulticenterretrospectivecohortstudy AT hannibalkassahunabate theeffectofanticoagulationdosageontheoutcomeofhospitalizedcovid19patientsinethiopiaamulticenterretrospectivecohortstudy AT rawleighcraighowe theeffectofanticoagulationdosageontheoutcomeofhospitalizedcovid19patientsinethiopiaamulticenterretrospectivecohortstudy AT abelgirmatessema effectofanticoagulationdosageontheoutcomeofhospitalizedcovid19patientsinethiopiaamulticenterretrospectivecohortstudy AT zekariasmasreshamengiste effectofanticoagulationdosageontheoutcomeofhospitalizedcovid19patientsinethiopiaamulticenterretrospectivecohortstudy AT tsegayegebreyeshundie effectofanticoagulationdosageontheoutcomeofhospitalizedcovid19patientsinethiopiaamulticenterretrospectivecohortstudy AT hailemichaelgetachewyosef effectofanticoagulationdosageontheoutcomeofhospitalizedcovid19patientsinethiopiaamulticenterretrospectivecohortstudy AT dawitkebedehuluka effectofanticoagulationdosageontheoutcomeofhospitalizedcovid19patientsinethiopiaamulticenterretrospectivecohortstudy AT abebawbekeleseyoum effectofanticoagulationdosageontheoutcomeofhospitalizedcovid19patientsinethiopiaamulticenterretrospectivecohortstudy AT hannibalkassahunabate effectofanticoagulationdosageontheoutcomeofhospitalizedcovid19patientsinethiopiaamulticenterretrospectivecohortstudy AT rawleighcraighowe effectofanticoagulationdosageontheoutcomeofhospitalizedcovid19patientsinethiopiaamulticenterretrospectivecohortstudy |