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Publications

Journal Article Ppublish

PubMed: 40028842 DOI: 10.1161/JAHA.123.034186

Patterns of Prophylactic Anticoagulation Among Patients Hospitalized for COVID-19: An Analysis of the American Heart Association COVID-19 Cardiovascular Disease Registry.

J Am Heart Assoc 14(5):e034186

Authors: Mathew S Lopes, Hsin-Fang Li, Reed J D Sorensen, Sandeep Das, Steven M Bradley, James A de Lemos, Gregory A Roth, Tracy Wang, Erin A Bohula, Ty J Gluckman

Affiliations

  • Division of Cardiovascular Medicine Brigham and Women's Hospital Boston MA USA.
  • Center for Cardiovascular Analytics, Research, and Data Science (CARDS) Providence Heart Institute Portland OR USA.
  • Institute for Health Metrics and Evaluation, University of Washington Seattle WA USA.
  • UT Southwestern Medical Center Dallas TX USA.
  • Minneapolis Heart Institute Minneapolis MN USA.
  • Division of Cardiology, Department of Medicine University of Washington Seattle WA USA.
  • Duke Clinical Research Institute Durham NC USA.

Abstract

BACKGROUND

Limited knowledge exists about prophylactic anticoagulation patterns in patients hospitalized for COVID-19.

METHODS AND RESULTS

We conducted a retrospective cohort study using American Heart Association COVID-19 Cardiovascular Disease Registry data from May 2020 to March 2022. We included patients without preexisting indications for or contraindications to anticoagulation, excluding those with missing anticoagulation data. Patients were categorized by the highest anticoagulation dose received. Multilevel logistic regression was used to assess the relationship between anticoagulation use/dose, patient demographics, clinical presentation, in-hospital course, institutional characteristics, and admission date, accounting for hospital clustering. Among 26 775 patients, 4157 (16%) received no anticoagulation, 15 617 (58%) low-dose, 3071 (11%) intermediate-dose, and 3930 (15%) full-dose anticoagulation. Significant hospital-level variability occurred for any anticoagulation use (range, 0%-98%; P<0.0001) and by dose (full anticoagulation range, 0%-85%; P<0.0001). Controlling for hospital variability, older age, male sex, non-White race, higher body mass index, higher platelets, corticosteroid use, and intensive care unit admission were positively associated with any anticoagulation use. Older age, male sex, higher body mass index, higher platelets, corticosteroid use, intensive care unit admission, mechanical ventilation, and admission before October 2020 were associated with higher anticoagulation dose (full versus low dose). Rates of no anticoagulation significantly increased in both intensive care unit and non-intensive care unit strata over time (P trend=0.01 and <0.0001, respectively).

CONCLUSIONS

In this large real-world analysis, nearly 1 in 6 patients hospitalized for COVID-19 received no prophylactic anticoagulation. Patient and disease characteristics associated with thrombotic risk and COVID-19 severity correlated with anticoagulation strategy. Importantly, substantial institutional differences emerged, highlighting gaps between clinical practice and guideline recommendations.

MeSH

Registries, Heart Diseases, Body Mass Index, Heart, Adrenal Cortex Hormones, Cardiovascular Diseases, Covid-19, Sex, Intensive Care Units, Blood Platelets