Early initiation of prophylactic anticoagulation for prevention of coronavirus disease 2019 mortality in patients admitted to hospital in the United States: cohort study

This suggests for hospitalized patients, I think that is way too late. I bet doing this early, prior to hospitalization might prevent long-haulers.

But I'm not medically trained so don't listen to me. Don't tough this out at home. 

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Heparin:

Why I'm getting heparin.  Heparin binds to cells at a site adjacent to ACE2, the portal for SARS-CoV-2 infection, and "potently" blocks the virus, which could open up therapy options.

Anticoagulation Again Shown to Improve Survival in COVID-19 Patients;-Mortality risk about 50% lower

But this research below suggests not due to bleeding risks. I'll take that risk since I've been on warfarin, aspirin and had Lovenox shots. 

COVID-Related Strokes Especially Severe, Result in Worse Outcomes

The paragraph from there:

"On the other hand, in most patients with COVID-19 associated ischaemic stroke, very early anti-coagulation is probably not warranted as a strategy to prevent inpatient stroke recurrence, as this outcome is too uncommon to justify the increased risk of secondary haemorrhage," according to the group.(So you wait until the clots are severe before you do anti-coagulation. OK, not for me.)

The latest here:

Early initiation of prophylactic anticoagulation for prevention of coronavirus disease 2019 mortality in patients admitted to hospital in the United States: cohort study

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n311 (Published 11 February 2021) Cite this as: BMJ 2021;372:n311

Read our latest coverage of the coronavirus outbreak

1. Christopher T Rentsch, assistant professor1 2,  
2. Joshua A Beckman, professor3,  
3. Laurie Tomlinson, associate professor1,  
4. Walid F Gellad, associate professor4 5 6,  
5. Charles Alcorn, programmer7,  
6. Farah Kidwai-Khan, database administrator2 8,  
7. Melissa Skanderson, data scientist2,  
8. Evan Brittain, associate professor9,  
9. Joseph T King Jr, associate professor2 10,  
10. Yuk-Lam Ho, data analyst11,  
11. Svetlana Eden, research assistant professor12,  
12. Suman Kundu, database administrator13,  
13. Michael F Lann, programmer7,  
14. Robert A Greevy Jr, associate professor14,  
15. P Michael Ho, professor15,  
16. Paul A Heidenreich, professor16 17,  
17. Daniel A Jacobson, computational systems biologist18,  
18. Ian J Douglas, professor1,  
19. Janet P Tate, associate professor2 8,  
20. Stephen J W Evans, professor1,  
21. David Atkins, director19,  
22. Amy C Justice, professor2 8 20,  
23. Matthew S Freiberg, professor13 21

Author affiliations

1. Correspondence to: C T Rentsch christopher.rentsch@lshtm.ac.uk (or @darthctr on Twitter)

• Accepted 1 February 2021

Abstract

Objective To evaluate whether early initiation of prophylactic anticoagulation compared with no anticoagulation was associated with decreased risk of death among patients admitted to hospital with coronavirus disease 2019 (covid-19) in the United States.

Design Observational cohort study.

Setting Nationwide cohort of patients receiving care in the Department of Veterans Affairs, a large integrated national healthcare system.

Participants All 4297 patients admitted to hospital from 1 March to 31 July 2020 with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and without a history of anticoagulation.

Main outcome measures The main outcome was 30 day mortality. Secondary outcomes were inpatient mortality, initiating therapeutic anticoagulation (a proxy for clinical deterioration, including thromboembolic events), and bleeding that required transfusion.

Results Of 4297 patients admitted to hospital with covid-19, 3627 (84.4%) received prophylactic anticoagulation within 24 hours of admission. More than 99% (n=3600) of treated patients received subcutaneous heparin or enoxaparin. 622 deaths occurred within 30 days of hospital admission, 513 among those who received prophylactic anticoagulation. Most deaths (510/622, 82%) occurred during hospital stay. Using inverse probability of treatment weighted analyses, the cumulative incidence of mortality at 30 days was 14.3% (95% confidence interval 13.1% to 15.5%) among those who received prophylactic anticoagulation and 18.7% (15.1% to 22.9%) among those who did not. Compared with patients who did not receive prophylactic anticoagulation, those who did had a 27% decreased risk for 30 day mortality (hazard ratio 0.73, 95% confidence interval 0.66 to 0.81). Similar associations were found for inpatient mortality and initiation of therapeutic anticoagulation. Receipt of prophylactic anticoagulation was not associated with increased risk of bleeding that required transfusion (hazard ratio 0.87, 0.71 to 1.05). Quantitative bias analysis showed that results were robust to unmeasured confounding (e-value lower 95% confidence interval 1.77 for 30 day mortality). Results persisted in several sensitivity analyses.

Conclusions Early initiation of prophylactic anticoagulation compared with no anticoagulation among patients admitted to hospital with covid-19 was associated with a decreased risk of 30 day mortality and no increased risk of serious bleeding events. These findings provide strong real world evidence to support guidelines(Why not a protocol?) recommending the use of prophylactic anticoagulation as initial treatment for patients with covid-19 on hospital admission.