Thrombotic complications and anticoagulation in COVID-19 pneumonia: a New York City hospital experience

• Published in: Annals of hematology 2020-10, Vol.99 (10), p.2323-2328
• Main Authors: Hanif, Ahmad, Khan, Sumera, Mantri, Nikhitha, Hanif, Sana, Saleh, Muhamed, Alla, Yamini, Chinta, Siddharth, Shrestha, Nikee, Ji, Wenyan, Attwood, Kristopher, Adrish, Muhammad, Jain, Kevin R.
• Format: Article
• Language: English
• Subjects: Aged; Anticoagulants - administration & dosage; Anticoagulants - therapeutic use; Betacoronavirus; Black or African American; Black People; Coronavirus Infections - complications; Coronavirus Infections - therapy; Coronaviruses; COVID-19; Female; Hematology; Hemorrhage - epidemiology; Hispanic or Latino; Hospitals, Community; Hospitals, Urban; Humans; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; New York City - epidemiology; Oncology; Original; Original Article; Pandemics; Pneumonia, Viral - complications; Pneumonia, Viral - therapy; Respiration, Artificial; Retrospective Studies; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Stroke - epidemiology; Thrombosis - epidemiology; Thrombosis - prevention & control; Thrombosis - virology; Treatment Outcome; Venous Thromboembolism - epidemiology; Ventilation
• ISSN: 0939-5555; 1432-0584; 1432-0584
• DOI: 10.1007/s00277-020-04216-x

Infection with SARS-CoV-2 (COVID-19) can cause prothrombotic complications. We aim to study the frequency of thrombotic complications and impact of anticoagulation on outcomes in hospitalized patients. We conducted a retrospective chart review of 921 consecutive patients admitted to our hospital with COVID-19. Patients were divided into four groups depending on whether they were on anticoagulation prior to admission, started anticoagulation during the admission, received prophylactic anticoagulation, or did not receive any anticoagulation. At the time of analysis, 325 patients (35.3%) had died, while 544 patients (59%) had been discharged resulting in inpatient mortality of 37.3%. Male sex, age > 65 years, and high D-dimer at admission were associated with higher mortality. Sixteen patients (1.7%) had venous thromboembolism confirmed with imaging, 11 patients had a stroke, and 2 patients developed limb ischemia. Treatment with therapeutic anticoagulation was associated with improved inpatient mortality compared with prophylactic anticoagulation alone (63% vs 86.2%, p < 0.0001) in patients requiring mechanical ventilation. Other outcomes such as rates of liberation from mechanical ventilation and duration of mechanical ventilation were not significantly impacted by the type of anticoagulation.