Intermediate-dose anticoagulation, aspirin, and in-hospital mortality in COVID-19: a propensity score-matched analysis

  1. Matthew L. Meizlish
  2. George Goshua
  3. Yiwen Liu
  4. Rebecca Fine
  5. Kejal Amin
  6. Eric Chang
  7. Nicholas DeFilippo
  8. Craig Keating
  9. Yuxin Liu
  10. Michael Mankbadi
  11. Dayna McManus
  12. Stephen Wang
  13. Christina Price
  14. Robert D. Bona
  15. Cassius Iyad Ochoa Chaar
  16. Hyung J. Chun
  17. Alexander B. Pine
  18. Henry M. Rinder
  19. Jonathan Siner
  20. Donna S. Neuberg
  21. Kent A. Owusu
  22. Alfred Ian Lee
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Abstract

Background

Thrombotic complications occur at high rates in hospitalized patients with COVID-19, yet the impact of intensive antithrombotic therapy on mortality is uncertain.

Research Question

How does in-hospital mortality compare with intermediate-versus prophylactic-dose anticoagulation, and separately with in-hospital aspirin versus no antiplatelet therapy, in treatment of COVID-19?

Study Design and Methods

Using data from 2785 hospitalized adult COVID-19 patients, we established two separate, nested cohorts of patients (1) who received intermediate- or prophylactic-dose anticoagulation (“anticoagulation cohort”, N = 1624), or (2) who were not on home antiplatelet therapy and received either in-hospital aspirin or no antiplatelet therapy (“aspirin cohort”, N = 1956). Propensity score matching utilizing various markers of illness severity and other patient-specific covariates yielded treatment groups with well-balanced covariates in each cohort. The primary outcome was cumulative incidence of in-hospital death.

Results

Among propensity score-matched patients in the anticoagulation cohort (N = 382), in a multivariable regression model, intermediate-compared to prophylactic-dose anticoagulation was associated with a significantly lower cumulative incidence of in-hospital death (hazard ratio 0.518 [0.308-0.872]). Among propensity-score matched patients in the aspirin cohort (N = 638), in a multivariable regression model, in-hospital aspirin compared to no antiplatelet therapy was associated with a significantly lower cumulative incidence of in-hospital death (hazard ratio 0.522 [0.336-0.812]).

Interpretation

In this propensity score-matched, observational study of COVID-19, intermediate-dose anticoagulation and aspirin were each associated with a lower cumulative incidence of in-hospital death.

Summary conflict of interest statements

No conflict of interest exists for any author on this manuscript.

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