Full Dose Anticoagulation Linked to Prolonged COVID-19 Survival

Ghassan Samaha, MD

Administration of full dose anticoagulation showed a survival benefit in hospitalized predominantly black patients with coronavirus disease 2019 (COVID-19​), according to findings presented at CHEST 2020 Annual Meeting.

In comparison with standard prophylaxis anticoagulation, full dose anticoagulation was especially effective in those with a higher D-dimer, CRP, and Sepsis-Induced Coagulopathy (SIC) score at baseline.

Using chart reviews of patients, Ghassan Samaha, MD, of SUNY Downstate Medical Center, and colleagues conducted a retrospective observational study at the University Hospital of Brooklyn, New York.

Inclusion criteria were age ≥18 years, confirmed COVID-19 infection, and available baseline D-dimer levels. Patients were then divided by whether they received anticoagulant or prophylactic dose.

The investigators collected variables based on demographics, comorbidities, laboratory results, type of anticoagulation, major bleeds, and Sepsis-Induced Coagulopathy (SIC) score. Samaha and team determined survival at 28 days using follow-up clinic and telehealth visit notes.

Overall, they assessed a total of 138 hospitalized patients, Of the total 86.2% were black, and 56% were males. The median age of the population was 66.6 years. Additionally, up to 85.5% received full dose anticoagulant.

Thus, the median hospital course of all patients was 12 days (IQR, 7.00-24.25).

Furthermore, for the full dose anticoagulant group, the Kaplan Meier median survival was 25 days (95% CI, 21.9-28.1]—versus 9 days for those who received prophylactic dose (95% CI, 6.4–11.6).

The investigators reported that full dose anticoagulant resulted in a decreased mortality (HR, .387; 95% CI, 0.204-0.734; P = .004).

The multivariate proportional hazard  adjusted for D-dimer, SIC score and CRP level was 0.159 (95% CI, 0.070-0.361; P<.001).

They also noted that patients who received full dose anticoagulant had higher D-dimer, CRP, and SIC scores at baseline.

Kaplan Meier median survival for direct oral anticoagulants (DOAC) was 20 days (95% CI, 11.1-28.9), compared with 25 days for low molecular weight heparin (LMWH). Thus, there was no difference in survival between DOAC and LMWH.

And finally, full dose anticoagulant was halted in 11 patients—9 for major bleeds and 2 for trending hemoglobin. However, they determined those findings to be statistically insignificant (Pearson’s chi-square = 4.716 [P = .09]).

Infection with COVD-19 has been associated with coagulopathy and a high incidence of thromboembolic events; therefore, the investigators have noted the clinical implications and potential of these findings.

“Empiric full dose anticoagulation has a role to play in the clinical management of high-risk hospitalized patients with COVID -19 infection while awaiting definitive therapies,” they wrote.

They acknowledged a need to conduct further investigations with a randomized control trial of full dose anticoagulation in COVID -19 infection.

The study, “Impact of Full Dose Anticoagulation in Hospitalized Predominantly Black Patients with Sars-Cov-2 Infection: A Retrospective Single Center Experience,” was published online as a late-breaking abstract by CHEST.