Evidence map›Paper›PMID 32860872›Full record

ArticleJournal of the American College of Cardiology2020

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 and 11 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American College of Cardiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 261 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
261citing papers in PubMed, 10 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

261 citing papers in PubMed, 10 syntheses or guidelines pooled it.

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  8. Characteristics of published/registered clinical trials on COVID-19 treatment: A systematic review.Daru : journal of Faculty of Pharmacy, Tehran University of Medical Sciences · 2021
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  10. Current evidence for COVID-19 therapies: a systematic literature review.European respiratory review : an official journal of the European Respiratory Society · 2021
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201 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

21 authors.

Girish N NadkarniMount Sinai Covid Informatics Center, New York, New York; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; The Hasso Plattner Institute of Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York; The Charles Bronfman Institute of Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: https://twitter.com/girish_nadkarni.
Anuradha LalaMount Sinai Covid Informatics Center, New York, New York; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: anu.lala@mountsinai.org.
Emilia BagiellaDepartment of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Pathology, Molecular and Cell-based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: https://twitter.com/emiliabagiella.
Helena L ChangDepartment of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; The Center for Biostatistics at the Icahn School of Medicine at Mount Sinai, New York, New York.
Pedro R MorenoThe Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
Elisabet PujadasDepartment of Pathology, Molecular and Cell-based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Varun ArvindThe Center for Biostatistics at the Icahn School of Medicine at Mount Sinai, New York, New York; Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, New York.
Sonali BoseDepartment of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Alexander W CharneyMount Sinai Covid Informatics Center, New York, New York; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York.
Martin D ChenDepartment of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Carlos Cordon-CardoDepartment of Pathology, Molecular and Cell-based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Andrew S DunnDepartment of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Michael E FarkouhPeter Munk Cardiac Centre and the Heart and Stroke Richard Lewar Centre of Excellence, University of Toronto, Toronto, Ontario, Canada.
Benjamin S GlicksbergMount Sinai Covid Informatics Center, New York, New York; The Hasso Plattner Institute of Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York.
Arash KiaDepartment of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
Roopa Kohli-SethInstitute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Matthew A LevinMount Sinai Covid Informatics Center, New York, New York; Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Prem TimsinaDepartment of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
Shan ZhaoDepartment of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Zahi A FayadMount Sinai Covid Informatics Center, New York, New York; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.
Valentin FusterThe Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain. Electronic address: valentin.fuster@mountsinai.org.

Funding

MSHS Translational Science HubUL1TR001433 · NCATS · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · PI WRIGHT, ROSALIND J · 2015 to 2019
$26.6M
NCATS NIH HHS UL1 TR001433
6 · The paper itself

Abstract

backgroundThromboembolic 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.

objectivesThe purpose of this study was to examine association of AC with in-hospital outcomes and describe thromboembolic findings on autopsies.

methodsThis 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.

resultsAmong 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.

conclusionsAC 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.

Indexed as

AnticoagulantsCoronavirus InfectionsPandemicsPneumonia, ViralPost-Exposure ProphylaxisThromboembolismAgedAutopsyBetacoronavirusBlood CoagulationCOVID-19FemaleHemorrhageHospitalizationHospital MortalityHumansAnticoagulantsanticoagulationCOVID-19intubationmortality

Identifiers

PMID32860872
PMCPMC7449655

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.