Treating hospitalized COVID-19 patients with anticoagulants blood thinners that slow down clotting may improve their chances of survival, researchers from the Mount Sinai COVID Informatics Center report. The study, published in the May 6 issue of the Journal of the American College of Cardiology, could provide new insight on how to treat and manage coronavirus patients once they are admitted to the hospital.
The study found that hospitalized COVID-19 patients treated with anticoagulants had improved outcomes both in and out of the intensive care unit setting. The research also showed that the difference in bleeding events among patients treated with and without anticoagulants was not significant. The Mount Sinai researchers say their work outlines an important therapeutic pathway for COVID-19 patients.
The publication of this study follows recent research out of the Icahn School of Medicine at Mount Sinai that shows a large number of patients hospitalized with COVID-19 have developed high levels of life-threatening blood clots, leading to potentially deadly thromboembolic events.
A team of investigators evaluated records of 2,773 confirmed COVID-19-positive patients admitted to five hospitals in the Mount Sinai Health System in New York City (The Mount Sinai Hospital, Mount Sinai West, Mount Sinai Morningside, Mount Sinai Queens, and Mount Sinai Brooklyn) between March 14 and April 11, 2020. They specifically looked at survival rates for patients placed on blood thinners versus those not placed on blood thinners. The researchers took certain risk factors into account before evaluating the effectiveness of anticoagulation, including age, ethnicity, pre-existing conditions, and those already on blood thinners.
Of the COVID-19 patients analyzed, 786 (28 percent) received a full-treatment dose of anticoagulants a higher dose than what is typically given for blood clot prevention, and one that is usually given to those who already have clots or are suspected to have clots. Treatment with anticoagulants was associated with improved hospital survival among COVID-19 patients both in and out of the intensive care unit setting. Of the patients who did not survive, those on anticoagulants died after spending an average of 21 days in the hospital, compared to the non- anticoagulant patients who died after an average of 14 days in the hospital. The effect of anticoagulation had a more pronounced effect on ventilated patients 62.7 percent of intubated patients who were not treated with anticoagulants died, compared to 29.1 percent for intubated patients treated with anticoagulants. Of the intubated patients who did not survive, those with no anticoagulants died after 9 days, while those on anticoagulants died after 21 days.
All patients in the study had blood work done when they arrived at the hospital, which included measuring various inflammatory markers. The analysis of their records showed patients who received anticoagulants had higher inflammatory markers compared to patients not treated with anticoagulants. This may suggest patients with more severe illness may benefit from anticoagulants early on.
The observational study also explored the association of systemic anticoagulant treatment with bleeding events. Major bleeding was defined as 1) hemoglobin <7 g/dL and any red blood cell transfusion; 2) at least 2 units of red blood cell transfusion within 48 hours; or 3) a diagnosis code for major bleeding including intracranial hemorrhage; hematemesis; melena; peptic ulcer with hemorrhage; colon, rectal, or anal hemorrhage; hematuria; ocular hemorrhage; and acute hemorrhagic gastritis. Among those who did not receive anticoagulants, 38 (1.9 percent) patients had bleeding events, compared to 24 (3 percent) among those who received anticoagulants, p=0.2).