Anticoagulation, Bleeding, Mortality, and Pathology in Hospitalized Patients With COVID-19

Girish N. Nadkarni, Anuradha Lala, Emilia Bagiella, Helena L. Chang, Pedro R. Moreno, Elisabet Pujadas, Varun Arvind, Sonali Bose, Alexander W. Charney, Martin D. Chen, Carlos Cordon-Cardo, Andrew S. Dunn, Michael E. Farkouh, Benjamin S. Glicksberg, Arash Kia, Roopa Kohli-Seth, Matthew A. Levin, Prem Timsina, Shan Zhao, Zahi A. FayadValentin Fuster

Research output: Contribution to journalArticlepeer-review

346 Scopus citations


Background: Thromboembolic disease is common in coronavirus disease-2019 (COVID-19). There is limited evidence on the association of in-hospital anticoagulation (AC) with outcomes and postmortem findings. Objectives: The purpose of this study was to examine association of AC with in-hospital outcomes and describe thromboembolic findings on autopsies. Methods: This retrospective analysis examined the association of AC with mortality, intubation, and major bleeding. Subanalyses were also conducted on the association of therapeutic versus prophylactic AC initiated ≤48 h from admission. Thromboembolic disease was contextualized by premortem AC among consecutive autopsies. Results: Among 4,389 patients, median age was 65 years with 44% women. Compared with no AC (n = 1,530; 34.9%), therapeutic AC (n = 900; 20.5%) and prophylactic AC (n = 1,959; 44.6%) were associated with lower in-hospital mortality (adjusted hazard ratio [aHR]: 0.53; 95% confidence interval [CI]: 0.45 to 0.62 and aHR: 0.50; 95% CI: 0.45 to 0.57, respectively), and intubation (aHR: 0.69; 95% CI: 0.51 to 0.94 and aHR: 0.72; 95% CI: 0.58 to 0.89, respectively). When initiated ≤48 h from admission, there was no statistically significant difference between therapeutic (n = 766) versus prophylactic AC (n = 1,860) (aHR: 0.86; 95% CI: 0.73 to 1.02; p = 0.08). Overall, 89 patients (2%) had major bleeding adjudicated by clinician review, with 27 of 900 (3.0%) on therapeutic, 33 of 1,959 (1.7%) on prophylactic, and 29 of 1,530 (1.9%) on no AC. Of 26 autopsies, 11 (42%) had thromboembolic disease not clinically suspected and 3 of 11 (27%) were on therapeutic AC. Conclusions: AC was associated with lower mortality and intubation among hospitalized COVID-19 patients. Compared with prophylactic AC, therapeutic AC was associated with lower mortality, although not statistically significant. Autopsies revealed frequent thromboembolic disease. These data may inform trials to determine optimal AC regimens.

Original languageEnglish
Pages (from-to)1815-1826
Number of pages12
JournalJournal of the American College of Cardiology
Issue number16
StatePublished - 20 Oct 2020


  • COVID-19
  • anticoagulation
  • intubation
  • mortality


Dive into the research topics of 'Anticoagulation, Bleeding, Mortality, and Pathology in Hospitalized Patients With COVID-19'. Together they form a unique fingerprint.

Cite this