Admission Rothman Index, Aspirin, and Intermediate Dose Anticoagulation Effects on Outcomes in COVID-19: A Multi-Site Propensity Matched Analysis
Goshua et al.,
Admission Rothman Index, Aspirin, and Intermediate Dose Anticoagulation Effects on Outcomes in COVID-19: A..,
Blood, doi:10.1182/blood-2020-143349
PSM retrospective 2,785 hospitalized patients in the USA, showing lower mortality and higher ventilation and ICU admission with aspirin treatment.
risk of death, 35.0% lower, OR 0.65, p = 0.04, treatment 319, control 319, propensity score matching, RR approximated with OR.
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risk of mechanical ventilation, 49.0% higher, OR 1.49, p = 0.04, treatment 319, control 319, propensity score matching, RR approximated with OR.
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risk of ICU admission, 45.0% higher, OR 1.45, p = 0.02, treatment 319, control 319, propensity score matching, RR approximated with OR.
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Goshua et al., 5 Nov 2020, retrospective, USA, peer-reviewed, 15 authors.
Abstract: 332.ANTICOAGULATION AND ANTITHROMBOTIC THERAPY | NOVEMBER 5, 2020
Admission Rothman Index, Aspirin, and Intermediate
Dose Anticoagulation Effects on Outcomes in
COVID-19: A Multi-Site Propensity Matched Analysis
*,2
1
George Goshua, MD, Yiwen Liu,
*,4
Rebecca Fine, MD,
Kejal Amin, PharmD,
*,8
Dayna McManus, PharmD,
*,10
Chaar, MD,
Matthew L. Meizlish, MSc,
Eric Chang, MD,
Adina Petrosan, PharmD,
Hyung J. Chun, MD,
2
*,5
*,11
*,9
*,6
*,3
*,7
Yuxin Liu, MD,
Cassius Ilya Ochoa
*,12
Nicholas A. Defilippo, PharmD,
S. Neuberg, ScD, Kent A. Owusu, PharmD,
*,13
Donna
Alfred Ian Lee, MD PhD
14
1
Section of Hematology, Yale University School of Medicine, New Haven, CT
2
Department of Data Science, Dana-Farber Cancer Institute, Boston, MA
3
Yale University School of Medicine, New Haven,
4
Department of Internal Medicine, Yale University School of Medicine, New Haven,
5
Department of Pharmacy, Yale-New Haven Hospital, New Haven,
6
Section of Hematology, Yale University School of Medicine, New Haven,
7
Yale University, New Haven, CT
8
Department of Pharmacy, Yale University School of Medicine, New Havem,
9
Department of Pharmacy, Yale New Haven Hospital, New Haven,
10
Yale School of Medicine, New Haven, CT
11
Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
12
University of Connecticut, Storrs,
13
Yale New Haven Hospital, New Haven, CT
14
Section of Hematology, Department of Internal Medicine, Yale
University School of Medicine and Yale Cancer Center, New Haven, CT
Blood (2020) 136 (Supplement 1) : 23.
http://doi.org/10.1182/blood-2020-143349
Introduction: Venous thromboembolism and in-situ small vessel thrombosis are increased in hospitalized
patients with COVID-19 in several patient cohorts. Endotheliopathy and activation of both platelets
and coagulation predict critical illness and death. For these reasons the use of anti-platelet agents
and increased-intensity anticoagulation in the care of hospitalized patients with COVID-19 is under
intense study in several clinical trials. We sought to examine the impact of aspirin and anticoagulation on
hospitalization outcomes.
Methods: We examined outcomes in a large multi-site cohort of consecutive, hospitalized, COVID-19
laboratory confirmed patients under a risk-stratified treatment algorithm from March 13 through June
18, with a focus on efficacy of aspirin and/or increased-intensity anticoagulation. Out of 4150 identified
hospitalized patients with COVID-19, we created 3 study cohorts. The overall cohort (2785 patients)
excluded pediatric patients, those with incomplete electronic data, and those with multiple admissions.
The aspirin (1956 patients) and anticoagulation (1623 patients) cohorts were nested within the overall
cohort; the former excluded patients on any home anti-platelet therapy or those who received non-aspirin
anti-platelet therapy in the hospital, while the latter excluded patients who did not receive prophylactic or
intermediate dose anticoagulation in the hospital. The primary outcome was in-hospital death. Secondary
outcomes were time-to-death with a competing risk (time-to-hospital-discharge), escalation to ICU,
length-of-stay and use of mechanical ventilation. Variables examined included age, gender, BMI, race,
Rothman Index (RI), D-dimer (DD) and patient co-morbidities including cardiovascular disease, chronic
kidney disease, and prior VTE. The aspirin and anticoagulation..
Late treatment
is less effective
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