Results of a study published in The Journal of Infectious Diseases show that anticoagulants were commonly used among patients hospitalized with COVID-19 infection until the emergence of the Omicron variant.
Researchers conducted a retrospective cohort study from April 2020 through 2022 to evaluate the use of anticoagulants among patients hospitalized with COVID-19 infection. Patient data were captured from the National COVID Cohort Collaborate. Eligible patients were those with laboratory-confirmed SARS-CoV-2 and no diagnosis prior to hospitalization supporting an indication for anticoagulants. Poisson regression was used to determine utilization patterns and factors associated with therapeutic dosing.
The final analysis included a total of 162,842 patients, of whom the mean age was 56 years, 49% were men, 50% were non-Hispanic White, and the mean BMI was 31 kg/m2. Common comorbidities among the population included diabetes (24%), chronic pulmonary disease (13%), and kidney disease (9%). In regard to anticoagulant use, receipt of therapeutic dosing was more common among older patients (mean, 61 years) and those who required longer hospital stays (mean, 13 days).
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Anticoagulants were used among 64% of patients overall, with 40% and 24% receiving prophylactic and therapeutic dosing, respectively. Although the use of anticoagulants remained stable from April 2020 through November 2021, the percentage of patients receiving prophylactic and therapeutic dosing decreased following the emergence of the Omicron variant (31% and 20%, respectively.
In univariate analyses, significant predictors of therapeutic dosing were as follows:
- Older age (relative risk [RR], 1.02; 95% CI, 1.02-1.02);
- Male vs female sex (RR, 1.36; 95% CI, 1.34-1.39);
- Obesity (RR, 1.32; 95% CI, 1.28-1.36);
- Prolonged hospitalization (RR, 1.01; 95% CI, 1.01-1.01); and
- Invasive mechanical ventilation (RR, 2.16; 95% CI, 2.12-2.20).
Similar findings were observed in a multivariable analysis, with the addition of non-Hispanic Black, Asian, and Hispanic race/ethnicity as significant predictors of therapeutic dosing.
Study limitations include insufficient data on anticoagulant dosing across all institutions, as well as the inability to differentiate between diagnostic codes and positive laboratory results as the primary cause for COVID-19 hospitalizations. In addition, these results may not be generalizable to community-based hospitals.
According to the researchers, “Our results suggest that the practice of AC [anticoagulation] use may not necessarily be influenced by guidelines but may be driven by clinicians’ assessment of risk and benefit.”
Disclosures: Multiple authors declared affiliations with pharmaceutical, biotech, and/or device companies. Please see the original reference for a full list of disclosures.
References
Lee E, Bates B, Kuhrt N, et al. National trends in anticoagulation therapy for COVID-19 hospitalized adults in the United States: analyses of the National COVID Cohort Collaborative. J Infect Dis. Published online June 2, 2023. doi:10.1093/infdis/jiad194
This article originally appeared on Infectious Disease Advisor
