Background Coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state. Limited data exist informing the relationship between anticoagulation therapy and risk for COVID-19 related hospitalization and mortality. Methods We evaluated all patients over the age of 18 diagnosed with COVID-19 in a prospective cohort study from March 4th to August 27th, 2020 among 12 hospitals and 60 clinics of M Health Fairview system (USA). We investigated the relationship between (1) 90-day anticoagulation therapy among outpatients before COVID-19 diagnosis and the risk for hospitalization and mortality and (2) Inpatient anticoagulation therapy and mortality risk. Findings Of 6195 patients, 598 were immediately hospitalized and 5597 were treated as outpatients. The overall case-fatality rate was 2•8% ( n = 175 deaths). Among the patients who were hospitalized, the inpatient mortality was 13%. Among the 5597 COVID-19 patients initially treated as outpatients, 160 (2.9%) were on anticoagulation and 331 were eventually hospitalized (5.9%). In a multivariable analysis, outpatient anticoagulation use was associated with a 43% reduction in risk for hospital admission, HR (95% CI = 0.57, 0.38–0.86), p = 0.007, but was not associated with mortality, HR (95% CI=0.88, 0.50 – 1.52), p = 0.64. Inpatients who were not on anticoagulation (before or after hospitalization) had an increased risk for mortality, HR (95% CI = 2.26, 1.17–4.37), p = 0.015. Interpretation Outpatients with COVID-19 who were on outpatient anticoagulation at the time of diagnosis experienced a 43% reduced risk of hospitalization. Failure to initiate anticoagulation upon hospitalization or maintaining outpatient anticoagulation in hospitalized COVID-19 patients was associated with increased mortality risk. Funding No funding was obtained for this study.
【저자키워드】 COVID-19, Mortality, anticoagulation, Hospitalization, COVID-19, Coronavirus disease 2019, D-dimer, COPD, Chronic obstructive pulmonary disease, Outpatient, RT-PCR, Reverse transcriptase-polymerase chain reaction, WBC, White blood cell, SARS-COV-2, severe acute respiratory syndrome coronavirus-2, Inpatient, OPAC, outpatient persistent anticoagulation therapy, IPAC, inpatient anticoagulation therapy, EHR, electronic health records, EMR, electronic medical records, DOAC, direct oral anticoagulant, mg/dl, milligram per deciliter, ACEi, angiotensin-converting enzyme inhibitors, ARBs, angiotensin receptor blockers, MI, prior myocardial infarction, VTE, venous thromboembolism, IRB, institutional review board, DIC, disseminated intravascular coagulation, HIT, heparin-induced thrombocytopenia, HR, hazard ratio, SD, standard deviations, SE, standard errors, CI, confidence intervals, %, percentage, (n), number, SBP-min, minimum systolic blood pressure, SpO2-min, minimum oxygen saturation, T1DM, type 1 diabetes mellitus, T2DM, type 2 diabetes mellitus, CKD, chronic kidney disease, CO2, carbon dioxide, HCT, hematocrit, RDW, red blood cell distribution width, SBP, systolic blood pressure, 【초록키워드】 Coronavirus disease 2019, therapy, Hospitalized, hospital, Diagnosis, risk, prospective cohort study, clinics, Patient, COVID-19 diagnosis, age, Hospital admission, outpatients, USA, patients, funding, hospitalized COVID-19 patient, mortality risk, deaths, COVID-19 patient, hypercoagulable, increased risk, reduced risk, failure, multivariable analysis, increased mortality, finding, the patient, investigated, evaluated, overall case-fatality rate, treated, reduction in, was obtained, diagnosed with COVID-19, Limited, with COVID-19, 【제목키워드】 therapy, risk, death, Hospital admission, COVID-19 patient,