-Author name in bold denotes the presenting author
-Asterisk * with author name denotes a Non-ASH member
Clinically Relevant Abstract denotes an abstract that is clinically relevant.

PhD Trainee denotes that this is a recommended PHD Trainee Session.

Ticketed Session denotes that this is a ticketed session.

577 Increasing Doses of Anticoagulation Are Associated with Improved Survival in Hospitalized COVID-19 PatientsClinically Relevant Abstract

Program: Oral and Poster Abstracts
Type: Oral
Session: 332. Anticoagulation and Antithrombotic Therapy: COVID-19, Obesity and Hemorrhagic Complications
Hematology Disease Topics & Pathways:
Coronaviruses, SARS-CoV-2/COVID-19, anticoagulant drugs, Adult, Non-Biological, Therapies, Study Population, Clinically relevant
Monday, December 7, 2020: 9:15 AM

Filip Ionescu, MD1*, Girish B Nair, MD, MS, FACP2*, Ioana Petrescu, MD1*, Anish S Konde, MD3*, Markie Sue Zimmer, MD4, Nwabundo Anusim, MBBS5, Vishal Jindal, MD6*, Susanna Gaikazian, MD6, Joseph Anderson, MD7*, Michael Stender, MD8, Marianne Terese Huben, DO9* and Ishmael Jaiyesimi, DO, MS6

1Internal Medicine, William Beaumont Hospital, Royal Oak, MI
2Pulmonary and Critical Care Medicine, William Beaumont Hospital, Royal Oak, MI
3Department of Hematology and Oncology, Oakland University/William Beaumont School of Medicine, Royal Oak, MI
4Oakland University / William Beaumont Hospital, Royal Oak, MI
5Oakland University / William Beaumont Hospital, Troy, MI
6William Beaumont Hospital, Royal Oak, MI
7Oakland University/William Beaumont School of Medicine, Royal Oak
8Hematology Oncology, Oakland University, William Beaumont Hospital, Royal Oak, MI
9Oakland University/William Beaumont School of Medicine, Royal Oak, MI

Background: Hypercoagulability may contribute to COVID-19 pathogenicity. Evidence comparing clinical outcomes among patients with COVID-19 receiving therapeutic compared to prophylactic dose anticoagulation is limited. We evaluated whether therapeutic anticoagulation (tAC) is associated with improved survival compared to prophylactic (pAC) and no anticoagulation (AC) in hospitalized COVID-19 patients.

Methods: This was a retrospective, multi-center cohort study of consecutive COVID-19 patients admitted between March 13th, 2020 and May 5th, 2020 to eight hospitals within a large academic system in Southeast Michigan, USA. Participants were assigned to three groups based on whether they received no AC, pAC throughout most of their hospitalization, or at least 3 days of tAC. Major bleeding was defined as transfusion of five or more units of packed red blood cells within 48 hours regardless of hemoglobin level, hemoglobin < 7g/dL and any red blood cell transfusion or a diagnosis code for major bleeding during the hospitalization or radiological evidence of intracranial hemorrhage

Results: A total of 3480 patients were included (mean age, 64.5 years [17.0]; 51.5% female; 52.1% black and 40.6% white). 18.5% (n=642) were treated in the intensive care unit (ICU). 60.9% received pAC (n=2121), 28.7% received at least 3 days of tAC (n=998), and 10.4% (n=361) did not receive AC. Propensity score (PS) weighted Kaplan-Meier plot demonstrated a statistical difference in the 25-day survival probability in the tAC group compared to the pAC group (57.5% vs 50.7%, Figure). In a PS weighted multivariate proportional hazards model adjusting for age, body mass index and ICU status, AC was associated with a reduced risk of death at both prophylactic (hazard ratio [HR] 0.35 [95% confidence interval {CI} 0.22-0.54]) and therapeutic doses (HR 0.14 [95% CI 0.05-0.23]) compared to no AC. Major bleeding occurred more frequently among tAC patients (81 [8.1%]) compared to those who received no AC (20 [5.5%]) or pAC (46 [2.2%]).

Conclusions: Higher doses of AC are associated with lower mortality in hospitalized COVID-19 patients. The lowest hazard ratio was observed in ICU patients, but risk was also significantly lower in non-ICU hospitalized patients. Bleeding occurred more frequently with higher doses of anticoagulation. Ongoing randomized trials are warranted to prospectively evaluate efficacy and risk of tAC in patients with COVID-19.

Disclosures: No relevant conflicts of interest to declare.

*signifies non-member of ASH