Abstract
Here we analyze hospitalized and ICU COVID‐19 patient outcomes from the international VIRUS registry (https://clinicaltrials.gov/ct2/show/NCT04323787). We find that COVID‐19 patients administered unfractionated heparin but not enoxaparin have a higher mortality‐rate (390 of 1,012 = 39%) compared to patients administered enoxaparin but not unfractionated heparin (270 of 1,939 = 14%), presenting a risk ratio of 2.79 (95% C.I.: [2.42, 3.16]; p‐value: 4.45e‐52). This difference persists even after balancing on a number of covariates including demographics, comorbidities, admission diagnoses, and method of oxygenation, with an increased mortality rate on discharge from the hospital of 37% (268 of 733) for unfractionated heparin vs. 22% (154 of 711) for enoxaparin, presenting a risk ratio of 1.69 (95% C.I.: [1.4 2, 2.00]; p‐value: 1.5e‐8). In these balanced cohorts, a number of complications occurred at an elevated rate for patients administered unfractionated heparin compared to patients administered enoxaparin, including acute kidney injury, acute cardiac injury, septic shock, and anemia. Furthermore, a higher percentage of Black/African American COVID patients (414 of 1,294 [32%]) were noted to receive unfractionated heparin compared to White/Caucasian COVID patients (671 of 2,644 [25%]), risk ratio 1.26 (95%CI [1.14, 1.40], p‐value: 7.5e‐5). After balancing upon available clinical covariates, this difference in anticoagulant use remained statistically significant (311 of 1,047 [30%] for Black/African American vs. 263 of 1,047 [25%] for White/Caucasian, p‐value: 0.02, risk ratio 1.18, 95%CI [1.03, 1.36]). While retrospective studies cannot suggest any causality, these findings motivate the need for follow‐up prospective research into the observed racial disparity in anticoagu lant use and outcomes for severe COVID‐19 patients.
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