Contemporary outcomes of long-term anticoagulation in COVID-19 patients: a regression matched sensitivity analysis of the national inpatient sample

ABSTRACT

Background

The role of oral anticoagulation during the COVID-19 pandemic has been debated widely. We studied the clinical outcomes of COVID-19 hospitalizations in patients who were on long-term anticoagulation.

Research Design and Methods

The Nationwide Inpatient Sample (NIS) database from 2020 was queried to identify COVID-19 patients with and without long-term anticoagulation. Multivariate regression analysis was used to calculate the adjusted odds ratio (aOR) of in-hospital outcomes.

Results

Of 1,060,925 primary COVID-19 hospitalizations, 102,560 (9.6%) were on long-term anticoagulation. On adjusted analysis, COVID-19 patients on anticoagulation had significantly lower odds of in-hospital mortality (aOR 0.61, 95% CI 0.58–0.64, P < 0.001), acute myocardial infarction (aOR 0.72, 95% CI 0.63–0.83, P < 0.001), stroke (aOR 0.79, 95% CI 0.66–0.95, P < 0.013), ICU admissions, (aOR 0.53, 95% CI 0.49–0.57, P < 0.001) and higher odds of acute pulmonary embolism (aOR 1.47, 95% CI 1.34–1.61, P < 0.001), acute deep vein thrombosis (aOR 1.17, 95% CI 1.05–1.31, P = 0.005) compared to COVID-19 patients who were not on anticoagulation.

Conclusions

Compared to COVID-19 patients not on long-term anticoagulation, we observed lower in-hospital mortality, stroke and acute myocardial infarction in COVID-19 patients on long-term anticoagulation. Prospective studies are needed for optimal anticoagulation strategies in hospitalized patients.

KEYWORDS:

• COVID-19
• anticoagulants
• SARS-CoV-2
• in-hospital outcomes
• thrombosis

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14779072.2023.2234282

Additional information

Funding

This paper was not funded.