Intermediate-dose anticoagulation, aspirin tied to lower incidence of in-hospital death among inpatients with COVID-19

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Intermediate-dose anticoagulation and aspirin were each associated with a lower cumulative incidence of in-hospital death among hospitalised patients with coronavirus disease 2019 (COVID-19), according to a study published in the American Journal of Hematology.

“High VTE (venous thromboembolism) rates have been reported in critically ill patients with COVID-19 despite the use of prophylactic anticoagulation,” wrote Matthew L. Meizlish, Yale School of Medicine, New Haven, Connecticut, and colleagues. “A common global practice has been to administer escalated intensities of antithrombotic therapy beyond standard prophylactic-dose anticoagulation in hospitalised patients with COVID-19. To date, there has been little evidence to support this practice.”

For their study, the researchers used propensity score matching and multivariable regression analyses in 2 cohorts of hospitalised patients with COVID-19: those who received intermediate- or prophylactic-dose anticoagulation (n = 1,624) and those who were not on home antiplatelet therapy and received either in-hospital aspirin or no antiplatelet therapy (n = 1,956).

“In contrast to many other studies, we utilised propensity score matching and multivariable regression analysis in order to diminish treatment selection bias by generating treatment and control groups with well-balanced covariates, thereby allowing for a more reliable comparison of potential treatment effects,” the authors explained.

Half of the patients were male (50.1%) and the majority (58.4%) were aged older than 60 years. Among all patients, 383 (13.8%) died in the hospital, 2,330 (83.7%) were discharged alive, and 72 (2.6%) remained in the hospital at the time of data abstraction.

Among propensity score-matched patients in the anticoagulation cohort (n = 382), in a multivariable regression model, intermediate-dose anticoagulation was associated with a significantly lower cumulative incidence of in-hospital death compared with prophylactic-dose (hazard ratio [HR] = 0.518; 95% confidence interval [CI], 0.308-0.872).

Among propensity-score matched patients in the aspirin cohort (n = 638), in a multivariable regression model, in-hospital aspirin was associated with a significantly lower cumulative incidence of in-hospital death compared with no antiplatelet therapy (HR = 0.522; 95% CI, 0.336-0.812).

“In our large, observational study of hospitalised patients with COVID-19, using propensity score matching and multivariable regression analyses, we observed a mortality benefit with intermediate- compared with prophylactic-dose anticoagulation and, separately, with in-hospital aspirin compared with no antiplatelet therapy,” the authors concluded. “Our findings suggest that increased-intensity anticoagulation and antiplatelet therapy may be beneficial in the treatment of COVID-19. We await the results of several randomised clinical trials to more definitively elucidate the impact of these therapies in COVID-19.”