Patients who receive thin-blooded anticoagulants (prophylactic anticoagulants) within 24 hours of admission to hospital with covid-19 are less likely to die compared to those who do not, a study published by Am BMJ today.
Clinical trials are now underway to see if prophylactic anticoagulants could be an effective treatment for covid-19. Meanwhile, the researchers say these findings provide strong evidence in the world to support their early use among hospitalized patients with covid-19.
Some covid deaths are believed to be due to developing blood clots in primary veins and arteries. Anticoagulants prevent the formation of blood clots and have antiviral and potentially anti-inflammatory properties, so they may be particularly effective in patients with covid-19 , but results from previous studies have been inconclusive.
To further investigate this, a team of researchers in the UK and US estimated the effect of prophylactic anticoagulants when given promptly after hospital admission on the risk of death and severe stroke. among patients with covid-19.
Their findings are based on data from the U.S. Department of Veterans Affairs for 4,297 patients (average age 68 years; 93% men) who were admitted to the hospital with covid-19 between March 1 and July 31, 2020.
Other potentially important factors were noted including age, race, baseline condition, medication history, weight, and smoking status. The researchers then tracked these patients to see who died or suffered a severe inflammatory event within 30 days of admission to the hospital.
A total of 3,627 (84.4%) patients received prophylactic anticoagulation within 24 hours of admission and 622 died (14.5%) within 30 days.
30-day mortality at 14.3% among those who received prophylactic anticoagulation compared with 18.7% among those who did not – a relative risk reduction as high as 34% and an overall risk reduction of 4.4%.
This benefit appeared to be greater among patients who were not admitted to the intensive care unit (ICU) within 24 hours of admission to the hospital.
Getting prophylactic anticoagulation was not associated with an increased risk of severe bleeding.
This was a large, well-designed study using electronic health record data and highlighted a range of factors that may be influential. The results were also not changed after further studies, recommending that they stand up to scrutiny.
However, the researchers acknowledge that, due to the observational nature of the study, there is a degree of uncertainty that can only be addressed through randomized trials.
Until further confirmatory evidence is available, they conclude that these findings “provide strong evidence in the wider world to support guidelines recommending the use of prophylactic anticoagulation such as initial treatment for patients with covid-19 admitted to hospital. “
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