Blood thinners improve survival among hospitalized coronavirus patients, shows US study
Treating hospitalized Covid-19 patients with blood thinners or anticoagulants that slow down clotting can improve their chances of survival, according to researchers from the Mount Sinai Covid Informatics Center.
The analysis shows that blood thinners had a more pronounced effect on ventilated patients -- an estimated 70.9% of intubated patients who were treated with them survived, as compared to 37% of patients who were not treated with them. The study, published in the Journal of the American College of Cardiology, could provide new insight on how to treat and manage coronavirus patients once they are admitted to the hospital.
The researchers say that while these preliminary results have shown a positive impact on Covid-19 patients and potentially give them a greater chance of survival, more studies are needed to determine the effectiveness of widespread use of blood thinners in hospitalized Covid-19 patients.
“As a cardiologist who has been on service caring for Covid-19 patients for the last three 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," says co-researcher Dr Anu Lala, assistant professor of medicine (cardiology) at the Icahn School of Medicine at Mount Sinai, in the analysis.
The publication of this study follows recent research out of the Icahn School of Medicine at Mount Sinai that shows a large number of patients hospitalized with Covid-19 have developed high levels of life-threatening blood clots, say experts.
A team of investigators evaluated records of 2,773 confirmed coronavirus patients admitted to five hospitals in the Mount Sinai Health System in New York City, between March 14 and April 11. This includes the Mount Sinai Hospital, Mount Sinai West, Mount Sinai Morningside, Mount Sinai Queens, and Mount Sinai Brooklyn. The experts specifically looked at survival rates for patients placed on blood thinners versus those not placed on blood thinners.
The researchers took certain risk factors into account before evaluating the effectiveness of anticoagulation, including age, ethnicity, pre-existing conditions, and those already on blood thinners.
Of the Covid-19 patients analyzed, 786 (28%) received a full-treatment dose of blood thinners -- 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 analysis shows that treatment with blood thinners was associated with improved hospital survival among COVID-19 patients, both in and out of the intensive care unit setting. The research also shows that the difference in bleeding events among patients treated with and without blood thinners was not significant.
Of the patients who did not survive, those on blood thinners died after spending an average of 21 days in the hospital, compared to the non- anticoagulant patients, who died after an average of 14 days in the hospital.
The research team found that 62.7% of intubated patients who were not treated with anticoagulants died, compared to 29.1% for intubated patients treated with anticoagulants. Of the intubated patients who did not survive, those with no blood thinners died after 9 days, while those on anticoagulants died after spending an average of 21 days in the hospital.
The Mount Sinai researchers say their work outlines an important therapeutic pathway for Covid-19 patients. “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,” says senior corresponding author Dr Valentin Fuster, Director of Mount Sinai Heart, and physician-in-chief of the Mount Sinai Hospital.
“Using anticoagulants should be considered when patients get admitted to the ER 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,” recommends Dr Fuster.
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 to patients not treated with anticoagulants. This may suggest patients with more severe illness may benefit from anticoagulants early on,” says the research team.
According to the experts, the study is opening the door for a more extensive study that will be carried out with 5,000 Covid-19-positive patients, where the medical experts will evaluate the effectiveness of three types of antithrombotic therapy -- oral antithrombotic, subcutaneous heparin, and intravenous heparin.