Anticoagulants yield survival gains in Asians

Anticoagulant therapy appears to cut the risk of 29-day mortality in hospitalized COVID-19 patients who are receiving steroids and whose comorbidity and thrombosis risk may differ from those of other ethnic groups, as shown in a Japanese cohort study.

The study included 1,748 patients, among whom 367 were treated with anticoagulants during hospitalization. Compared with those who did not receive anticoagulant therapy, the patients who did were more likely to be older, men, have a higher body mass index (BMI), and higher D-dimer level at admission. Comorbidities such as hypertension, hyperlipidaemia, diabetes, and obesity were also more common among patients in the treatment vs no-treatment group.

The primary endpoint of 29-day mortality was 7.6 percent in the overall population (treatment group, 11.2 percent; no treatment group, 6.6 percent), 6 percent among patients who were not treated with steroids (treatment group, 12.3 percent; no-treatment group, 5.2 percent), and 11.2 percent among patients treated with steroids (treatment group, 10.5 percent; no treatment group, 11.8 percent).

There was no statistically significant difference in the primary endpoint seen between the treatment and no-treatment group in the overall population (hazard ratio [HR], 1.02, 95 percent confidence interval [CI], 0.80–1.29; p=0.99). The corresponding survival estimates for the group of patients who did not receive steroids and the group of those who received steroids were 1.31 (95 percent CI, 0.97–1.78; p=0.082) and 0.72 (95 percent CI, 0.5–1.03; 0.075), respectively.

The present data provide a rationale for promoting anticoagulation therapy in hospitalized COVID-19 patients in Asian countries, including Japan. Nevertheless, more studies are needed to determine the appropriate target population and treatment initiation.