Anticoagulation, Bleeding, Mortality, and Pathology in Hospitalized Patients With COVID-19

Nadkarni GN, Lala A, Bagiella E, et al. J Am Coll Cardiol. 2020 Oct 20;76(16):1815-1826. [CrossRef] [PubMed]

The authors retrospectively examined patterns of anticoagulation and effects of these treatments in nearly 4400 adults admitted to New York City hospitals with COVID-19. Of the patients, 45% received prophylactic anticoagulation, 21% received therapeutic anticoagulation, and the remainder received none. Overall, 24% of the patients died in the hospital. After multivariable adjustment, prophylactic and therapeutic treatment were each associated with roughly a 50% reduction in mortality, relative to no anticoagulation. Rates of major bleeding were low (2%–3%). In addition, of 26 autopsies performed, thromboembolic disease was found in 42%; most of these patients had not received therapeutic anticoagulation. These observations would support a prospective, randomized, multi-center study.