Association between pre-admission anticoagulation and in-hospital death, venous thromboembolism, and major bleeding among hospitalized COVID-19 patients in Japan
Motohiko Adomi
Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
Search for more papers by this authorToshiki Kuno
Department of Cardiology, Montefiore Medical Center/Albert Einstein Medical College, New York, New York, USA
Search for more papers by this authorJun Komiyama
Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
Search for more papers by this authorYuta Taniguchi
Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
Search for more papers by this authorToshikazu Abe
Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan
Search for more papers by this authorAtsushi Miyawaki
Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorShinobu Imai
Department of Drug Safety and Risk Management, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
Search for more papers by this authorKojiro Morita
Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorMakoto Saito
Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorHiroyuki Ohbe
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorTadashi Kamio
Division of Critical Care, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
Search for more papers by this authorNanako Tamiya
Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
Search for more papers by this authorCorresponding Author
Masao Iwagami
Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
Correspondence
Masao Iwagami, Department of Health Services Research, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, Japan.
Email: [email protected]
Search for more papers by this authorMotohiko Adomi
Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
Search for more papers by this authorToshiki Kuno
Department of Cardiology, Montefiore Medical Center/Albert Einstein Medical College, New York, New York, USA
Search for more papers by this authorJun Komiyama
Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
Search for more papers by this authorYuta Taniguchi
Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
Search for more papers by this authorToshikazu Abe
Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan
Search for more papers by this authorAtsushi Miyawaki
Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorShinobu Imai
Department of Drug Safety and Risk Management, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
Search for more papers by this authorKojiro Morita
Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorMakoto Saito
Division of Infectious Diseases, Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorHiroyuki Ohbe
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorTadashi Kamio
Division of Critical Care, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
Search for more papers by this authorNanako Tamiya
Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
Search for more papers by this authorCorresponding Author
Masao Iwagami
Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
Correspondence
Masao Iwagami, Department of Health Services Research, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, Japan.
Email: [email protected]
Search for more papers by this authorFunding information: Ministry of Health, Labour and Welfare Policy Research Grants, Japan, Grant/Award Number: 21AA2007
Abstract
Purpose
The coagulation activation leads to thrombotic complications such as venous thromboembolism (VTE) in patients with coronavirus disease-2019 (COVID-19). Prophylactic anticoagulation therapy has been recommended for hospitalized COVID-19 patients in clinical guidelines. This retrospective cohort study aimed to examine the association between pre-admission anticoagulation treatment and three outcomes: in-hospital death, VTE, and major bleeding among hospitalized COVID-19 patients in Japan.
Methods
Using a large-scale claims database built by the Medical Data Vision Co. in Japan, we identified patients hospitalized for COVID-19 who had outpatient prescription data at least once within 3 months before being hospitalized. Exposure was set as pre-admission anticoagulation treatment (direct oral anticoagulant or vitamin K antagonist), and outcomes were in-hospital death, VTE, and major bleeding. We conducted multivariable logistic regression analyses, adjusting for a single summarized score (a propensity score of receiving pre-admission anticoagulation) for VTE and major bleeding, due to the small number of outcomes.
Results
Among the 2612 analytic patients, 179 (6.9%) had pre-admission anticoagulation. Crude incidence proportions were 13.4% versus 8.5% for in-hospital death, 0.56% versus 0.58% for VTE, and 2.2% versus 1.1% for major bleeding among patients with and without pre-admission anticoagulation, respectively. Adjusted odds ratios (95% confidence intervals) were 1.25 (0.75–2.08) for in-hospital death, 0.21 (0.02–1.97) for VTE, and 2.63 (0.80–8.65) for major bleeding. Several sensitivity analyses did not change the results.
Conclusions
We found no evidence that pre-admission anticoagulation treatment was associated with in-hospital death. However, a larger sample size may be needed to conclude its effect on VTE and major bleeding.
CONFLICT OF INTEREST
Atsushi Miyawaki has a joint research project with MDV outside of this study and is receiving labor contributions. None of other authors declare any conflict of interest.
Supporting Information
| Filename | Description |
|---|---|
| pds5433-sup-0001-Tables.pdfPDF document, 113.9 KB | Table S1. Summary of previous studies regarding pre-admission anticoagulation and in-hospital mortality among COVID-19 patients. Table S2. Summary of previous studies regarding pre-admission anticoagulation and in-hospital incidence of VTE and major bleeding among COVID-19 patients. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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