Therapeutic Anticoagulation Is Associated with Decreased Mortality in Mechanically Ventilated COVID-19 Patients

  1. Muoi A. Trinh
  2. Daniel R. Chang
  3. Usha S. Govindarajulu
  4. Erica Kane
  5. Valentin Fuster
  6. Roopa Kohli-Seth
  7. Sanam Ahmed
  8. Matthew A Levin
  9. Martin D. Chen

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Abstract

Objective

To evaluate differences in morbidity and mortality among mechanically ventilated patients with COVID-19 treated with therapeutic versus prophylactic anticoagulation.

Methods

We performed a retrospective review of 245 COVID-19 positive patients admitted to the ICU requiring mechanical ventilation from March 1, 2020 through April 11, 2020 at Mount Sinai Hospital. Patients either received therapeutic anticoagulation for a minimum of 5 days or prophylactic dose anticoagulation. Morbidity and mortality data were analyzed.

Results

Propensity score (PS) weighted Kaplan-Meier plot demonstrated a survival advantage (57% vs. 25%) at 35 days from admission to the ICU in patients who received therapeutic anticoagulation for a minimum of 5 days compared to those who received prophylactic anticoagulation during their hospital course. A multivariate Cox proportional hazard regression model with PS weights to adjust for baseline differences found a 79% reduction in death in patients who were therapeutically anticoagulated HR 0.209, [95% Cl (0.10, 0.46), p < 0.001]. Bleeding complications were similar between both groups. A 26.7% [95% Cl (1.16, 1.39), p< 0.001] excess mortality was found for each 1 mg/dL rise in serum creatinine over a 21-day period.

Conclusions

Therapeutic anticoagulation is associated with a survival advantage among patients with COVID-19 who require mechanical ventilation in the ICU.

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  1. ScreenIT

    SciScore for 10.1101/2020.05.30.20117929: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Approval was obtained from Icahn School of Medicine at Mount Sinai Institutional Review Board (IRB-20–0342) to perform a retrospective review of all COVID-19 positive adult (age > 18) patients admitted to any of the ICU at The Mount Sinai Hospital between March 1, 2020 and April 11, 2020.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: There are several limitations to this study. First, due to its observational nature, there exists the potential for confounding. Although we attempted to control for this using a propensity matched model, the study took place during the COVID epidemic in NYC, when adjustments to our protocols and guidelines for therapy were constantly made as new information became available. The introduction of our anticoagulation protocol was one of these changes. We were concerned that the improved outcomes in the TA group could represent improvements in therapy as we gained experience managing these patients. We attempted to examine the effect of timing by analyzing the effect of date of intubation on outcome, which was not significant. Another limitation is our decision to exclude patients who died within 5 days of ICU admission (∼10% of ICU admissions). This potentially introduces immortal time bias.23,24 We felt however that including these patients would have introduced its own bias, since many of these patients died before having a chance to achieve full anti-coagulation, by falsely elevating the number of deaths among patients who were anticoagulated

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.05.30.20117929 on medRxiv