The current status of thrombosis and anticoagulation therapy in patients with COVID-19 in Japan: From the CLOT-COVID study

• Published in: Journal of cardiology 2022-10, Vol.80 (4), p.285-291
• Main Authors: Nishimoto, Yuji, Yachi, Sen, Takeyama, Makoto, Tsujino, Ichizo, Nakamura, Junichi, Yamamoto, Naoto, Nakata, Hiroko, Ikeda, Satoshi, Umetsu, Michihisa, Aikawa, Shizu, Hayashi, Hiroya, Satokawa, Hirono, Okuno, Yoshinori, Iwata, Eriko, Ogihara, Yoshito, Ikeda, Nobutaka, Kondo, Akane, Iwai, Takehisa, Yamada, Norikazu, Ogawa, Tomohiro, Kobayashi, Takao, Mo, Makoto, Yamashita, Yugo
• Format: Article
• Language: English
• Subjects: Anticoagulants; Anticoagulants - adverse effects; Asian; Cohort Studies; Coronavirus disease 2019; COVID-19; Humans; Japan; Japan - epidemiology; Original; Retrospective Studies; SARS-CoV-2; Thrombosis; Thrombosis - epidemiology; Thrombosis - etiology; Thrombosis - prevention & control; Venous Thromboembolism - drug therapy
• ISSN: 0914-5087; 1876-4738; 1876-4738
• DOI: 10.1016/j.jjcc.2022.03.015

Data on thrombosis and current real-world management strategies for anticoagulation therapy are scarce but important for understanding current issues and unmet needs of an optimal management of patients with coronavirus disease 2019 (COVID-19). The CLOT-COVID Study (thrombosis and antiCoaguLatiOn Therapy in patients with COVID-19 in Japan Study: UMIN000045800) was a retrospective, multicenter cohort study enrolling consecutive hospitalized patients with COVID-19 among 16 centers in Japan from April 2021 to September 2021, and we tried to capture the status of the patients in the fourth and fifth waves of the COVID-19 infections in Japan. We enrolled consecutive hospitalized patients who were diagnosed with COVID-19 and had a positive polymerase chain reaction test obtained from the hospital databases. Among 2894 patients with COVID-19, 1245 (43%) received pharmacological thromboprophylaxis. The proportion of pharmacological thromboprophylaxis increased according to the severity of the COVID-19 in 9.8% with mild COVID-19, 61% with moderate COVID-19, and 97% with severe COVID-19. The types and doses of anticoagulants varied widely across the participating centers. During the hospitalization, 38 patients (1.3%) and 126 (4.4%) underwent ultrasound examinations for the lower extremities and contrast-enhanced computed tomography examinations, respectively, and 55 (1.9%) developed thrombosis, mostly venous thromboembolism (71%). The incidence of thrombosis increased according to the severity of the COVID-19 in 0.2% with mild COVID-19, 1.4% with moderate COVID-19, and 9.5% with severe COVID-19. Major bleeding occurred in 57 patients (2.0%) and 158 (5.5%) died, and 81% of them were due to respiratory failure from COVID-19 pneumonia. In the present large-scale observational study, pharmacological thromboprophylaxis for hospitalized patients with COVID-19 was common especially in patients with severe COVID-19, and management strategies varied widely across the participating centers. The overall incidence of thrombosis was substantially low with an increased incidence according to the severity of the COVID-19. [Display omitted] •Data on thrombosis and anticoagulation therapy in coronavirus disease 2019 (COVID-19) patients are limited.•We evaluated 2894 hospitalized COVID-19 patients in the fourth and fifth waves.•Nearly half of the COVID-19 patients received a pharmacological thromboprophylaxis.•Management strategies varied widely across the participating centers.•Dur