May 6, 2020
Mount Sinai Study Finds Anticoagulants May Improve Survival in Hospitalized COVID-19 Patients
May 6, 2020—The Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai in New York, New York, announced the publication of a research letter from the Mount Sinai COVID Informatics Center reporting that treating hospitalized COVID-19 patients with anticoagulants may improve their chances of survival. The announcement stated that the study could provide new insight on how to treat and manage coronavirus patients once they are admitted to the hospital.
The research letter by Ishan Paranjpe, BS, et al is available online in Journal of the American College of Cardiology (JACC). It is included in the JACC’s COVID-19 Clinical Guidance for Global Cardiovascular Clinicians, a compendium of recently accepted manuscripts that the editors of the JACC journals editors hope will best inform health care clinicians’ decision-making.
According to Mount Sinai, the study found that hospitalized COVID-19 patients treated with anticoagulants had improved outcomes both in and out of the intensive care unit setting. The research also showed that the difference in bleeding events among patients treated with and without anticoagulants was not significant.
Investigators evaluated records of 2,773 confirmed COVID-19-positive patients admitted to five hospitals in the Mount Sinai Health System in New York City (Mount Sinai Hospital, Mount Sinai West, Mount Sinai Morningside, Mount Sinai Queens, and Mount Sinai Brooklyn) between March 14 and April 11, 2020. They specifically looked at survival rates for patients placed on blood thinners versus those not placed on blood thinners. Before evaluating the effectiveness of anticoagulation, certain risk factors were taken into account, including age, ethnicity, preexisting conditions, and already being on blood thinners.
Of the COVID-19 patients analyzed, 786 (28%) received a full-treatment dose of anticoagulants—a higher dose than what is typically given for blood clot prevention, and one that is usually given to those who already have clots or are suspected to have clots.
The investigators found:
- Treatment with anticoagulants was associated with improved hospital survival among COVID-19 patients both in and out of the intensive care unit setting.
- Of the patients who did not survive, those on anticoagulants died after spending an average of 21 days in the hospital, compared with the nonanticoagulant patients who died after an average of 14 days in the hospital.
- The effect of anticoagulation had a more pronounced effect on ventilated patients—62.7% of intubated patients who were not treated with anticoagulants died, compared with 29.1% of intubated patients treated with anticoagulants.
- Of the intubated patients who did not survive, those with no anticoagulants died after 9 days and those on anticoagulants died after 21 days.
Additionally, all patients in the study had blood work done when they arrived at the hospital, which included measuring various inflammatory markers. The analysis of their records showed patients who received anticoagulants had higher inflammatory markers compared with patients not treated with anticoagulants. This may suggest patients with more severe illness may benefit from anticoagulants early on.
The observational study also explored the association of systemic anticoagulant treatment with bleeding events, finding that bleeding events occurred in 1.9% (n = 38) of patients who did not receive anticoagulants versus 3% (n = 24) of patients who did receive anticoagulants (P = .2).
Major bleeding was defined as (1) hemoglobin < 7 g/dL and any red blood cell transfusion; (2) at least two units of red blood cell transfusion within 48 hours; or (3) a diagnosis code for major bleeding including intracranial hemorrhage; hematemesis; melena; peptic ulcer with hemorrhage; colon, rectal, or anal hemorrhage; hematuria; ocular hemorrhage; and acute hemorrhagic gastritis.
The Mount Sinai investigators stated that their work outlines an important therapeutic pathway for COVID-19 patients. Recent findings from the Icahn School of Medicine at Mount Sinai show that a large number of patients hospitalized with COVID-19 have developed high levels of life-threatening blood clots, leading to potentially deadly thromboembolic events.
Valentin Fuster, MD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital, is the senior corresponding author of the JACC research letter. Dr. Fuster is also Editor-in-Chief of JACC.
“This research demonstrates anticoagulants taken orally, subcutaneously, or intravenously may play a major role in caring for COVID-19 patients, and these may prevent possible deadly events associated with coronavirus, including heart attack, stroke, and pulmonary embolism,” stated Dr. Fuster in Mount Sinai’s press release. “Using anticoagulants should be considered when patients get admitted to the emergency room and have tested positive for COVID-19 to possibly improve outcomes. However, each case should be evaluated on an individualized basis to account for potential bleeding risk.”
Coauthor and investigator Anu Lala, MD, Assistant Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai, commented, “As a cardiologist who has been on service caring for COVID-19 patients for the last 3 weeks, I have observed an increased amount of blood clot cases among hospitalized patients, so it is critical to look at whether anticoagulants provide benefits for them. It’s important to note that further analysis and prospective studies are required to determine the effectiveness for widespread use of anticoagulants in hospitalized COVID-19 patients.”
Senior author Girish Nadkarni, MD, Co-Director of the Mount Sinai COVID Informatics Center, advised, “This study is opening the door for a more extensive study that will be carried out with 5,000 COVID-19–positive patients, where we will evaluate the effectiveness of three types of antithrombotic therapy—oral antithrombotic, subcutaneous heparin, and intravenous heparin—and then perhaps engage our data for prospective clinical trials. We are excited about these preliminary results that may have a positive impact on COVID-19 patients and potentially give them a greater chance of survival, although more studies are needed.”
David Reich, MD, President and Chief Operating Officer of The Mount Sinai Hospital, commented in the announcement, “We are hopeful that this report of the association of anticoagulation therapy with improved survival will be confirmed in future investigations. The astute scientists at Mount Sinai continue to analyze our data on COVID-19 patients in order to contribute to worldwide efforts to find effective treatments.”