(HealthDay)—Prophylactic-dose venous thromboembolism (VTE) anticoagulation may be optimal therapy for patients hospitalized with COVID-19, according to a study published online June 11 in JAMA Network Open.
Valerie M. Vaughn, M.D., from the University of Utah in Salt Lake City, and colleagues assessed trends in VTE prophylaxis and treatment-dose anticoagulation in patients hospitalized for COVID-19, as well as the association of anticoagulation strategies with in-hospital and 60-day mortality. The analysis included a pseudorandom sample of 1,351 patients hospitalized between March 7, 2020, and June 17, 2020, in 30 hospitals in Michigan.
The researchers found that 1.3 percent had a confirmed VTE, while 16.2 percent received treatment-dose anticoagulation. Across hospitals, 0 to 29 percent used treatment-dose anticoagulation without imaging, with increases over time (adjusted odds ratio [aOR], 1.46 per week; 95 percent confidence interval [CI], 1.31 to 1.61). Among the 1,127 patients who ever received anticoagulation, more than one-third (34.8 percent) missed two or more days of prophylaxis (range from 11 to 61 percent across hospitals), with a decrease in missed prophylaxis seen over time (aOR, 0.89 per week; 95 percent CI, 0.82 to 0.97). An association was seen between nonadherence to VTE prophylaxis and higher 60-day mortality (adjusted hazard ratio [aHR], 1.31; 95 percent CI, 1.03 to 1.67) but not in-hospital mortality (aHR, 0.97; 95 percent CI, 0.91 to 1.03). The investigators observed an association between receiving any dose of anticoagulation and lower in-hospital mortality (only prophylactic dose: aHR, 0.36 [95 percent CI, 0.26 to 0.52]; any treatment dose: aHR, 0.38 [95 percent CI, 0.25 to 0.58]), but only the prophylactic dose of anticoagulation remained associated with lower mortality at 60 days (prophylactic dose: aHR, 0.71 [95 percent CI, 0.51 to 0.90]; treatment dose: aHR, 0.92 [95 percent CI, 0.63 to 1.35]).
“Given that only prophylactic anticoagulation was associated with lower 60-day mortality, prophylactic-dose VTE prophylaxis may be the optimal therapy for patients hospitalized with COVID-19,” the authors write.
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