Outpatient and inpatient anticoagulation therapy and the risk for hospital admission and death among COVID-19 patients
Background: Coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state. Limited data exist informing the relationship between anticoagulation therapy and risk for COVID-19 related hospitalization and mortality. Methods: We evaluated all patients over the age of 18 diagnosed with...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-11-01
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| Series: | EClinicalMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537021004193 |
| _version_ | 1818358517158903808 |
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| author | Sameh M. Hozayen Diana Zychowski Sydney Benson Pamela L. Lutsey Jasmin Haslbauer Alexandar Tzankov Zachary Kaltenborn Michael Usher Surbhi Shah Christopher J. Tignanelli Ryan T. Demmer |
| author_facet | Sameh M. Hozayen Diana Zychowski Sydney Benson Pamela L. Lutsey Jasmin Haslbauer Alexandar Tzankov Zachary Kaltenborn Michael Usher Surbhi Shah Christopher J. Tignanelli Ryan T. Demmer |
| author_sort | Sameh M. Hozayen |
| collection | DOAJ |
| description | Background: Coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state. Limited data exist informing the relationship between anticoagulation therapy and risk for COVID-19 related hospitalization and mortality. Methods: We evaluated all patients over the age of 18 diagnosed with COVID-19 in a prospective cohort study from March 4th to August 27th, 2020 among 12 hospitals and 60 clinics of M Health Fairview system (USA). We investigated the relationship between (1) 90-day anticoagulation therapy among outpatients before COVID-19 diagnosis and the risk for hospitalization and mortality and (2) Inpatient anticoagulation therapy and mortality risk. Findings: Of 6195 patients, 598 were immediately hospitalized and 5597 were treated as outpatients. The overall case-fatality rate was 2•8% (n = 175 deaths). Among the patients who were hospitalized, the inpatient mortality was 13%. Among the 5597 COVID-19 patients initially treated as outpatients, 160 (2.9%) were on anticoagulation and 331 were eventually hospitalized (5.9%). In a multivariable analysis, outpatient anticoagulation use was associated with a 43% reduction in risk for hospital admission, HR (95% CI = 0.57, 0.38–0.86), p = 0.007, but was not associated with mortality, HR (95% CI=0.88, 0.50 - 1.52), p = 0.64. Inpatients who were not on anticoagulation (before or after hospitalization) had an increased risk for mortality, HR (95% CI = 2.26, 1.17–4.37), p = 0.015. Interpretation: Outpatients with COVID-19 who were on outpatient anticoagulation at the time of diagnosis experienced a 43% reduced risk of hospitalization. Failure to initiate anticoagulation upon hospitalization or maintaining outpatient anticoagulation in hospitalized COVID-19 patients was associated with increased mortality risk. Funding: No funding was obtained for this study. |
| first_indexed | 2024-12-13T20:30:15Z |
| format | Article |
| id | doaj.art-b7840d9f0d6441a2a2b5671425985b28 |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-12-13T20:30:15Z |
| publishDate | 2021-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-b7840d9f0d6441a2a2b5671425985b282022-12-21T23:32:27ZengElsevierEClinicalMedicine2589-53702021-11-0141101139Outpatient and inpatient anticoagulation therapy and the risk for hospital admission and death among COVID-19 patientsSameh M. Hozayen0Diana Zychowski1Sydney Benson2Pamela L. Lutsey3Jasmin Haslbauer4Alexandar Tzankov5Zachary Kaltenborn6Michael Usher7Surbhi Shah8Christopher J. Tignanelli9Ryan T. Demmer10Department of Medicine, Division of General Internal Medicine, Assistant Professor of Medicine, Hospitalist, University of Minnesota, Mayo Building, 420 Delaware Street, SE, 6 Floor, Room D694, Minneapolis, MN 55455, United States; Corresponding author.Department of Medical Education, University of Minnesota, United StatesDivision of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United StatesDivision of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United StatesPathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, SwitzerlandPathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, SwitzerlandDepartment of Medicine, Division of General Internal Medicine, Assistant Professor of Medicine, Hospitalist, University of Minnesota, Mayo Building, 420 Delaware Street, SE, 6 Floor, Room D694, Minneapolis, MN 55455, United StatesDepartment of Medicine, Division of General Internal Medicine, Assistant Professor of Medicine, Hospitalist, University of Minnesota, Mayo Building, 420 Delaware Street, SE, 6 Floor, Room D694, Minneapolis, MN 55455, United StatesDepartment of Hematology and oncology, Mayo Clinic, Arizona, United StatesDepartment of Surgery, University of Minnesota, Minneapolis, MN, United States; Institute for Health Informatics, University of Minnesota, Minneapolis, MN, United States; Department of Surgery, North Memorial Health Hospital, Robbinsdale, MN, United StatesDivision of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United StatesBackground: Coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state. Limited data exist informing the relationship between anticoagulation therapy and risk for COVID-19 related hospitalization and mortality. Methods: We evaluated all patients over the age of 18 diagnosed with COVID-19 in a prospective cohort study from March 4th to August 27th, 2020 among 12 hospitals and 60 clinics of M Health Fairview system (USA). We investigated the relationship between (1) 90-day anticoagulation therapy among outpatients before COVID-19 diagnosis and the risk for hospitalization and mortality and (2) Inpatient anticoagulation therapy and mortality risk. Findings: Of 6195 patients, 598 were immediately hospitalized and 5597 were treated as outpatients. The overall case-fatality rate was 2•8% (n = 175 deaths). Among the patients who were hospitalized, the inpatient mortality was 13%. Among the 5597 COVID-19 patients initially treated as outpatients, 160 (2.9%) were on anticoagulation and 331 were eventually hospitalized (5.9%). In a multivariable analysis, outpatient anticoagulation use was associated with a 43% reduction in risk for hospital admission, HR (95% CI = 0.57, 0.38–0.86), p = 0.007, but was not associated with mortality, HR (95% CI=0.88, 0.50 - 1.52), p = 0.64. Inpatients who were not on anticoagulation (before or after hospitalization) had an increased risk for mortality, HR (95% CI = 2.26, 1.17–4.37), p = 0.015. Interpretation: Outpatients with COVID-19 who were on outpatient anticoagulation at the time of diagnosis experienced a 43% reduced risk of hospitalization. Failure to initiate anticoagulation upon hospitalization or maintaining outpatient anticoagulation in hospitalized COVID-19 patients was associated with increased mortality risk. Funding: No funding was obtained for this study.http://www.sciencedirect.com/science/article/pii/S2589537021004193COVID-19AnticoagulationHospitalizationMortalityD-dimerInpatient |
| spellingShingle | Sameh M. Hozayen Diana Zychowski Sydney Benson Pamela L. Lutsey Jasmin Haslbauer Alexandar Tzankov Zachary Kaltenborn Michael Usher Surbhi Shah Christopher J. Tignanelli Ryan T. Demmer Outpatient and inpatient anticoagulation therapy and the risk for hospital admission and death among COVID-19 patients EClinicalMedicine COVID-19 Anticoagulation Hospitalization Mortality D-dimer Inpatient |
| title | Outpatient and inpatient anticoagulation therapy and the risk for hospital admission and death among COVID-19 patients |
| title_full | Outpatient and inpatient anticoagulation therapy and the risk for hospital admission and death among COVID-19 patients |
| title_fullStr | Outpatient and inpatient anticoagulation therapy and the risk for hospital admission and death among COVID-19 patients |
| title_full_unstemmed | Outpatient and inpatient anticoagulation therapy and the risk for hospital admission and death among COVID-19 patients |
| title_short | Outpatient and inpatient anticoagulation therapy and the risk for hospital admission and death among COVID-19 patients |
| title_sort | outpatient and inpatient anticoagulation therapy and the risk for hospital admission and death among covid 19 patients |
| topic | COVID-19 Anticoagulation Hospitalization Mortality D-dimer Inpatient |
| url | http://www.sciencedirect.com/science/article/pii/S2589537021004193 |
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