Anticoagulation Therapy Improves Outcomes for COVID-19 Patients

Mount Sinai researchers recently released additional information regarding the positive connection between anticoagulation therapy and improved survival among hospitalized COVID-19 patients.

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The study, published in the Journal of the American College of Cardiology, showed that anticoagulation therapy was associated with lower mortality and intubation among hospitalized COVID-19 patients.

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Specifically, compared to no anticoagulation (34.9 percent), therapeutic (20.5 percent), and prophylactic anticoagulation (44.6 percent), were associated with lower intubation and a nearly 50 percent higher chance of survival.

Although bleeding rates were surprisingly low among all patients, those on therapeutic blood thinners had 31 percent fewer intubations than those not on blood thinners, while individuals on prophylactic blood thinners had 28 percent fewer intubations.

Researchers evaluated medical records of 4,389 patients with confirmed COVID-19 admitted to five hospitals in the Mount Sinai System in New York City between March 1 and April 30, 2020.

They looked at survival and death rates for patients placed on therapeutic and prophylactic doses of blood thinners versus those not placed on blood thinners.

“This work from the Mount Sinai COVID Informatics Center provides additional insight on the role of anticoagulation in the management of patients admitted to the hospital with COVID-19,” Valentin Fuster, MD, PhD, director of Mount Sinai Heart, physician-in-chief of The Mount Sinai Hospital, senior corresponding author, said in the press release.

“Although this is an observational study, it helped in the design of a large-scale international clinical trial that we are coordinating.  The randomized trial focuses on those three antithrombotic regimens— therapeutic and prophylactic subcutaneous low-molecular weight heparin, and therapeutic oral apixaban.”

At the beginning of the pandemic, Mount Sinai researchers were one of the first to show that anticoagulation therapy was associated with improved survival among COVID-19 patients.

This study from the Mount Sinai COVID Informatics Center was a follow-up of previous Mount Sinai research that showed that treatment with anticoagulants was associated with improved outcomes both in and out of the intensive care unit.

"These observational analyses were done with the highest level of statistical rigor and provide exciting insights into the association of anticoagulation with critical in-hospital outcomes of mortality and intubation," said Girish Nadkarni, MD, co-Founder and co-director of the Mount Sinai COVID Informatics Center and clinical director of the Hasso Plattner Institute for Digital Health at Mount Sinai.

“We are excited that results from this observational study in one of the largest and most diverse hospitalized populations have led to an ongoing trial of type, duration, and doses of anticoagulation.”

Researchers were motivated by the discovery that many patients hospitalized with COVID-19 developed high levels of life-threatening blood clots.

Specifically, autopsy results of 26 COVID-19 patients showed that 42 percent had blood clots, pulmonary, brain, and/or heart, which were not suspected in the clinical setting.

These study findings suggest that treating patients with anticoagulants may be associated with improved survival.

Ultimately, researchers hope that this study will lead to a better understanding of the disease from a diagnostic perspective, therefore leading to improved outcomes and treatment for COVID-19 patients.

“This report is much more in-depth than our previous brief report and includes many more patients, longer follow-up, and rigorous methodology. Clearly, anticoagulation is associated with improved outcomes and bleeding rates appear to be low,” said Anu Lala, MD, assistant professor of medicine (cardiology) and director of heart failure research at the Icahn School of Medicine at Mount Sinai.

“As a clinician who has treated COVID-19 patients on the front lines, I recognize the importance of having answers as to what the best treatment for these patients entails, and these results will inform the design of clinical trials to ultimately give concrete information.”