National Trends in Anticoagulation Therapy for COVID-19 Hospitalized Adults in the United States: Analyses of the National COVID Cohort Collaborative
Authors: Lee Eileen , Bates Benjamin , Kuhrt Nathaniel , Andersen Kathleen M , Visaria Aayush , Patel Rachel , Setoguchi Soko ,   the N3C Consortium, Wilcox Adam B , Lee Adam M , Graves Alexis , Anzalone Alfred (Jerrod) , Manna Amin , Saha Amit , Olex Amy , Zhou Andrea , Williams Andrew E , Southerland Andrew , Girvin Andrew T , Walden Anita , Sharathkumar Anjali A , Amor Benjamin , Bates Benjamin , Hendricks Brian , Patel Brijesh , Alexander Caleb , Bramante Carolyn , Ward-Caviness Cavin , Madlock-Brown Charisse , Suver Christine , Chute Christopher , Dillon Christopher , Wu Chunlei , Schmitt Clare , Takemoto Cliff , Housman Dan , Gabriel Davera , Eichmann David A , Mazzotti Diego , Brown Don , Boudreau Eilis , Hill Elaine , Zampino Elizabeth , Marti Emily Carlson , Pfaff Emily R , French Evan , Koraishy Farrukh M , Mariona Federico , Prior Fred , Sokos George , Martin Greg , Lehmann Harold , Spratt Heidi , Mehta Hemalkumar , Liu Hongfang , Sidky Hythem , Hayanga J W Awori , Pincavitch Jami , Clark Jaylyn , Harper Jeremy Richard , Islam Jessica , Ge Jin , Gagnier Joel , Saltz Joel H , Saltz Joel , Loomba Johanna , Buse John , Mathew Jomol , Rutter Joni L , McMurry Julie A , Guinney Justin , Starren Justin , Crowley Karen , Bradwell Katie Rebecca , Walters Kellie M , Wilkins Ken , Gersing Kenneth R , Cato Kenrick Dwain , Murray Kimberly , Kostka Kristin , Northington Lavance , Pyles Lee Allan , Misquitta Leonie , Cottrell Lesley , Portilla Lili , Deacy Mariam , Bissell Mark M , Clark Marshall , Emmett Mary , Saltz Mary Morrison , Palchuk Matvey B , Haendel Melissa A , Adams Meredith , Temple-O'Connor Meredith , Kurilla Michael G , Morris Michele , Qureshi Nabeel , Safdar Nasia , Garbarini Nicole , Sharafeldin Noha , Sadan Ofer , Francis Patricia A , Burgoon Penny Wung , Robinson Peter , Payne Philip R O , Fuentes Rafael , Jawa Randeep , Erwin-Cohen Rebecca , Patel Rena , Moffitt Richard A , Zhu Richard L , Kamaleswaran Rishi , Hurley Robert , Miller Robert T , Pyarajan Saiju , Michael Sam G , Bozzette Samuel , Mallipattu Sandeep , Vedula Satyanarayana , Chapman Scott , O'Neil Shawn T , Setoguchi Soko , Hong Stephanie S , Johnson Steve , Bennett Tellen D , Callahan Tiffany , Topaloglu Umit , Sheikh Usman , Gordon Valery , Subbian Vignesh , Kibbe Warren A , Hernandez Wenndy , Beasley Will , Cooper Will , Hillegass William , Zhang Xiaohan Tanner , Alexander G Caleb , Chute Christopher G , Koraishy Farrukh M , Moffitt Richard A , Singh Jasvinder 
Published: June 2023

Abstract

Background
Anticoagulation (AC) utilization patterns and their predictors among hospitalized coronavirus disease 2019 (COVID-19) patients have not been well described.

Methods
Using the National COVID Cohort Collaborative, we conducted a retrospective cohort study (2020–2022) to assess AC use patterns and identify factors associated with therapeutic AC employing modified Poisson regression.

Results
Among 162 842 hospitalized COVID-19 patients, 64% received AC and 24% received therapeutic AC. Therapeutic AC use declined from 32% in 2020 to 12% in 2022, especially after December 2021. Therapeutic AC predictors included age (relative risk [RR], 1.02; 95% confidence interval [CI], 1.02–1.02 per year), male (RR, 1.29; 95% CI, 1.27–1.32), non-Hispanic black (RR, 1.16; 95% CI, 1.13–1.18), obesity (RR, 1.48; 95% CI, 1.43–1.52), increased length of stay (RR, 1.01; 95% CI, 1.01–1.01 per day), and invasive ventilation (RR, 1.64; 95% CI, 1.59–1.69). Vaccination (RR, 0.88; 95% CI, 84–.92) and higher Charlson Comorbidity Index (CCI) (RR, 0.98; 95% CI, .97–.98) were associated with lower therapeutic AC.

Conclusions
Overall, two-thirds of hospitalized COVID-19 patients received any AC and a quarter received therapeutic dosing. Therapeutic AC declined after introduction of the Omicron variant. Predictors of therapeutic AC included demographics, obesity, length of stay, invasive ventilation, CCI, and vaccination, suggesting AC decisions driven by clinical factors including COVID-19 severity, bleeding risks, and comorbidities.