TY - JOUR
T1 - Healthcare disparities among anticoagulation therapies for severe COVID-19 patients in the multi-site VIRUS registry
AU - Kirkup, Christian
AU - Pawlowski, Colin
AU - Puranik, Arjun
AU - Conrad, Ian
AU - O'Horo, John C.
AU - Gomaa, Dina
AU - Banner-Goodspeed, Valerie M.
AU - Mosier, Jarrod M.
AU - Zabolotskikh, Igor Borisovich
AU - Daugherty, Steven K.
AU - Bernstein, Michael A.
AU - Zaren, Howard A.
AU - Bansal, Vikas
AU - Pickering, Brian
AU - Badley, Andrew D.
AU - Kashyap, Rahul
AU - Venkatakrishnan, A. J.
AU - Soundararajan, Venky
N1 - Funding Information:
The authors would like to thank the SCCM Discovery VIRUS data registry and the collaborative co-authors listed in Table S4 for providing and maintaining the database of hospitalized COVID-19 patients which made this study possible. They are grateful to Vishakha Kumar for all the timely help and inputs, and to the SCCM colleagues for their internal review and feedback on this study. The autors are particularly thankful to Ognjen Gajic of the Mayo Clinic and Allan Walkey of Boston University for their helpful contributions to this study. Finally, they would like to thank Murali Aravamudan and Patrick Lenehan of nference for their reviews and feedback this manuscript.
Publisher Copyright:
© 2021 The Authors. Journal of Medical Virology Published by Wiley Periodicals LLC
PY - 2021/7
Y1 - 2021/7
N2 - Here we analyze hospitalized andintensive care unit coronavirus disease 2019 (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 1012 = 39%) compared to patients administered enoxaparin but not unfractionated heparin (270 of 1939 = 14%), presenting a risk ratio of 2.79 (95% confidence interval [CI]: [2.42, 3.16]; p = 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 versus 22% (154 of 711) for enoxaparin, presenting a risk ratio of 1.69 (95% CI: [1.42, 2.00]; p = 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 1294 [32%]) were noted to receive unfractionated heparin compared to White/Caucasian COVID patients (671 of 2644 [25%]), risk ratio 1.26 (95% CI: [1.14, 1.40]; p = 7.5e−5). After balancing upon available clinical covariates, this difference in anticoagulant use remained statistically significant (311 of 1047 [30%] for Black/African American vs. 263 of 1047 [25%] for White/Caucasian, p =.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 anticoagulant use and outcomes for severe COVID-19 patients.
AB - Here we analyze hospitalized andintensive care unit coronavirus disease 2019 (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 1012 = 39%) compared to patients administered enoxaparin but not unfractionated heparin (270 of 1939 = 14%), presenting a risk ratio of 2.79 (95% confidence interval [CI]: [2.42, 3.16]; p = 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 versus 22% (154 of 711) for enoxaparin, presenting a risk ratio of 1.69 (95% CI: [1.42, 2.00]; p = 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 1294 [32%]) were noted to receive unfractionated heparin compared to White/Caucasian COVID patients (671 of 2644 [25%]), risk ratio 1.26 (95% CI: [1.14, 1.40]; p = 7.5e−5). After balancing upon available clinical covariates, this difference in anticoagulant use remained statistically significant (311 of 1047 [30%] for Black/African American vs. 263 of 1047 [25%] for White/Caucasian, p =.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 anticoagulant use and outcomes for severe COVID-19 patients.
KW - biostatistics & bioinformatics
KW - epidemiology
KW - pandemics
KW - social science
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U2 - 10.1002/jmv.26918
DO - 10.1002/jmv.26918
M3 - Article
C2 - 33666246
AN - SCOPUS:85103384415
SN - 0146-6615
VL - 93
SP - 4303
EP - 4318
JO - Journal of medical virology
JF - Journal of medical virology
IS - 7
ER -