PDF(Pubmed)
Abstract：
UNASSIGNED: Coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state. Limited data exist informing the relationship between anticoagulation therapy and risk for COVID-19 related hospitalization and mortality.
UNASSIGNED: We evaluated all patients over the age of 18 diagnosed with COVID-19 in a prospective cohort study from March 4th to August 27th, 2020 among 12 hospitals and 60 clinics of M Health Fairview system (USA). We investigated the relationship between (1) 90-day anticoagulation therapy among outpatients before COVID-19 diagnosis and the risk for hospitalization and mortality and (2) Inpatient anticoagulation therapy and mortality risk.
UNASSIGNED: Of 6195 patients, 598 were immediately hospitalized and 5597 were treated as outpatients. The overall case-fatality rate was 2•8% (n = 175 deaths). Among the patients who were hospitalized, the inpatient mortality was 13%. Among the 5597 COVID-19 patients initially treated as outpatients, 160 (2.9%) were on anticoagulation and 331 were eventually hospitalized (5.9%). In a multivariable analysis, outpatient anticoagulation use was associated with a 43% reduction in risk for hospital admission, HR (95% CI = 0.57, 0.38-0.86), p = 0.007, but was not associated with mortality, HR (95% CI=0.88, 0.50 - 1.52), p = 0.64. Inpatients who were not on anticoagulation (before or after hospitalization) had an increased risk for mortality, HR (95% CI = 2.26, 1.17-4.37), p = 0.015.
UNASSIGNED: Outpatients with COVID-19 who were on outpatient anticoagulation at the time of diagnosis experienced a 43% reduced risk of hospitalization. Failure to initiate anticoagulation upon hospitalization or maintaining outpatient anticoagulation in hospitalized COVID-19 patients was associated with increased mortality risk.
UNASSIGNED: No funding was obtained for this study.
UNASSIGNED: We evaluated all patients over the age of 18 diagnosed with COVID-19 in a prospective cohort study from March 4th to August 27th, 2020 among 12 hospitals and 60 clinics of M Health Fairview system (USA). We investigated the relationship between (1) 90-day anticoagulation therapy among outpatients before COVID-19 diagnosis and the risk for hospitalization and mortality and (2) Inpatient anticoagulation therapy and mortality risk.
UNASSIGNED: Of 6195 patients, 598 were immediately hospitalized and 5597 were treated as outpatients. The overall case-fatality rate was 2•8% (n = 175 deaths). Among the patients who were hospitalized, the inpatient mortality was 13%. Among the 5597 COVID-19 patients initially treated as outpatients, 160 (2.9%) were on anticoagulation and 331 were eventually hospitalized (5.9%). In a multivariable analysis, outpatient anticoagulation use was associated with a 43% reduction in risk for hospital admission, HR (95% CI = 0.57, 0.38-0.86), p = 0.007, but was not associated with mortality, HR (95% CI=0.88, 0.50 - 1.52), p = 0.64. Inpatients who were not on anticoagulation (before or after hospitalization) had an increased risk for mortality, HR (95% CI = 2.26, 1.17-4.37), p = 0.015.
UNASSIGNED: Outpatients with COVID-19 who were on outpatient anticoagulation at the time of diagnosis experienced a 43% reduced risk of hospitalization. Failure to initiate anticoagulation upon hospitalization or maintaining outpatient anticoagulation in hospitalized COVID-19 patients was associated with increased mortality risk.
UNASSIGNED: No funding was obtained for this study.
摘要：
■2019年冠状病毒病（COVID-19）与高凝状态有关。关于抗凝治疗与COVID-19相关住院风险和死亡率之间关系的数据有限。
我们在3月4日至8月27日的一项前瞻性队列研究中评估了所有18岁以上被诊断为COVID-19的患者，2020年在MHealthFairview系统（美国）的12家医院和60家诊所中。我们调查了（1）COVID-19诊断前门诊患者90天抗凝治疗与住院和死亡风险之间的关系，以及（2）住院抗凝治疗和死亡风险之间的关系。
■在6195名患者中，598人立即住院，5597人作为门诊病人接受治疗。总病死率为2•8%（n=175例死亡）。在住院的病人中，住院患者死亡率为13%.在最初作为门诊患者治疗的5597例COVID-19患者中，160人(2.9%)接受抗凝治疗，331人最终住院(5.9%)。在多变量分析中，门诊抗凝治疗与住院风险降低43%相关,HR（95%CI=0.57，0.38-0.86），p=0.007，但与死亡率无关，HR（95%CI=0.88，0.50-1.52），p=0.64。未接受抗凝治疗（住院前或住院后）的住院患者死亡风险增加，HR（95%CI=2.26，1.17-4.37），p=0.015。
确诊时正在接受门诊抗凝治疗的COVID-19门诊患者的住院风险降低了43%。住院COVID-19患者在住院后未能开始抗凝治疗或维持门诊抗凝治疗与死亡风险增加相关。
■这项研究没有获得资助。
我们在3月4日至8月27日的一项前瞻性队列研究中评估了所有18岁以上被诊断为COVID-19的患者，2020年在MHealthFairview系统（美国）的12家医院和60家诊所中。我们调查了（1）COVID-19诊断前门诊患者90天抗凝治疗与住院和死亡风险之间的关系，以及（2）住院抗凝治疗和死亡风险之间的关系。
■在6195名患者中，598人立即住院，5597人作为门诊病人接受治疗。总病死率为2•8%（n=175例死亡）。在住院的病人中，住院患者死亡率为13%.在最初作为门诊患者治疗的5597例COVID-19患者中，160人(2.9%)接受抗凝治疗，331人最终住院(5.9%)。在多变量分析中，门诊抗凝治疗与住院风险降低43%相关,HR（95%CI=0.57，0.38-0.86），p=0.007，但与死亡率无关，HR（95%CI=0.88，0.50-1.52），p=0.64。未接受抗凝治疗（住院前或住院后）的住院患者死亡风险增加，HR（95%CI=2.26，1.17-4.37），p=0.015。
确诊时正在接受门诊抗凝治疗的COVID-19门诊患者的住院风险降低了43%。住院COVID-19患者在住院后未能开始抗凝治疗或维持门诊抗凝治疗与死亡风险增加相关。
■这项研究没有获得资助。
