Intermediate-dose anticoagulation and aspirin were found to be associated with lower in-hospital death in patients with coronavirus disease 2019 (COVID-19), according to research published in the American Journal of Hematology.
Critically ill patients with COVID-19 have high rates of thrombosis even with prophylactic anticoagulation.
The study authors retrospectively evaluated a cohort of 2785 adult patients from 5 medical centers within the Yale New Haven Health System to determine the effects of intermediate-dose anticoagulation or aspirin on in-hospital death over 30 days in patients with COVID-19.
The Yale New Haven Health System established antithrombotic guidelines for patients hospitalized with COVID-19. Treatment with prophylactic or intermediate-dose anticoagulation is based on patients’ D-dimer levels, which are measured daily. The hospital system also recommended aspirin 81 mg/d for all hospitalized patients with COVID-19.
While hospitalized, 13.8% of all patients studied died, and 2.6% were still hospitalized at the time of data collection.
The researchers created 2 retrospective cohorts. The first compared patients who received prophylactic-dose anticoagulation with those who received intermediate-dose anticoagulation (n=1624). They adjusted for other factors such as sex, obesity, and race, and found that patients treated with intermediate-dose anticoagulation had reduced in-hospital death compared with those treated with prophylactic-dose anticoagulation (hazard ratio [HR]=0.518).
The second cohort included patients who were not receiving antiplatelet therapy prior to hospitalization and who were administered either aspirin or no antiplatelet therapy during their stay (n=1956). Again, the authors adjusted for other risk factors. The group receiving aspirin had a lower incidence of in-hospital death (HR= 0.522).
The study results suggest intermediate-dose anticoagulation may be beneficial for patients hospitalized with COVID-19. Although limited data are available on the use of aspirin, randomized trials are underway. This study suggests a beneficial effect of aspirin in this setting.
Meizlish ML, Goshua G, Liu Y, et al. Intermediate-dose anticoagulation, aspirin, and in-hospital mortality in COVID-19: a propensity score-matched analysis. Am J Hematol. Published online January 21, 2021. doi:10.1002/ajh.26102