Thrombotic complications and anticoagulation in COVID-19 pneumonia: a New York City hospital experience
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ORIGINAL ARTICLE
Thrombotic complications and anticoagulation in COVID-19 pneumonia: a New York City hospital experience Ahmad Hanif 1 & Sumera Khan 2 & Nikhitha Mantri 2 & Sana Hanif 2 & Muhamed Saleh 2 & Yamini Alla 2 & Siddharth Chinta 2 & Nikee Shrestha 2 & Wenyan Ji 3 & Kristopher Attwood 3 & Muhammad Adrish 4 & Kevin R. Jain 1 Received: 27 May 2020 / Accepted: 10 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Infection with SARS-CoV-2 (COVID-19) can cause prothrombotic complications. We aim to study the frequency of thrombotic complications and impact of anticoagulation on outcomes in hospitalized patients. We conducted a retrospective chart review of 921 consecutive patients admitted to our hospital with COVID-19. Patients were divided into four groups depending on whether they were on anticoagulation prior to admission, started anticoagulation during the admission, received prophylactic anticoagulation, or did not receive any anticoagulation. At the time of analysis, 325 patients (35.3%) had died, while 544 patients (59%) had been discharged resulting in inpatient mortality of 37.3%. Male sex, age > 65 years, and high D-dimer at admission were associated with higher mortality. Sixteen patients (1.7%) had venous thromboembolism confirmed with imaging, 11 patients had a stroke, and 2 patients developed limb ischemia. Treatment with therapeutic anticoagulation was associated with improved inpatient mortality compared with prophylactic anticoagulation alone (63% vs 86.2%, p < 0.0001) in patients requiring mechanical ventilation. Other outcomes such as rates of liberation from mechanical ventilation and duration of mechanical ventilation were not significantly impacted by the type of anticoagulation. Keywords COVID-19 . Thrombosis . Anticoagulation . Mortality . Venous thromboembolism
Introduction The coronavirus pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Since the disease first appeared in December 2019, it has been spreading rapidly throughout the world. Infection with SARS CoV-2 (COVID-19) can result in a wide range of symptoms [1]. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00277-020-04216-x) contains supplementary material, which is available to authorized users. * Ahmad Hanif [email protected] 1
Department of Medicine, Division of Hematology & Oncology, BronxCare Hospital Center, Bronx, NY, USA
2
Department of Medicine, BronxCare Hospital Center, Bronx, NY, USA
3
Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
4
Department of Medicine, Division of Pulmonary and Critical Care, BronxCare Hospital Center, Bronx, NY, USA
Patients who develop pneumonia usually require admission to hospital for respiratory support and tend to have a poor prognosis. Although initially considered to be a predominantly respiratory infection, COVID-19 has been shown to have multiorgan involvement. A study by Tang et al. showed that elevated D-dimer leve
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