Giving this type of medicine to COVID-19 patients may improve survival rates

Supportive clinical treatment is currently the only medicinal measure at our disposal, with respect to the COVID-19 pandemic. The lion’s share of pharmaceuticals on offer can be purchased without a prescription at your local drug store. 

Nonsteroidal anti-inflammatory drugs to reduce fever and mitigate headaches, supplements to boost the immune system, hydration and plenty of rest will do the trick for 80% of coronavirus cases.  The rest will invariably have to seek medical intervention. 

Thankfully, therapeutics targeted at critical manifestations of SARS-CoV-2 infection is gaining momentum. 

According to a new meta-analysis of 2,773 COVID-19 records published in the Journal of the American College of Cardiology, blood thinners (anticoagulants) dramatically improve outcomes for both moderate admissions and for patients placed in intensive care units. The reasoning is multifaceted, but a sizable portion of coronavirus patients evidence abnormally high levels of blood inflammation in the early stages of the disease. 

“This research demonstrates anticoagulants taken orally, subcutaneously, or intravenously may play a major role in caring for COVID-19 patients, and these may prevent possible deadly events associated with coronavirus, including heart attack, stroke, and pulmonary embolism,” says senior corresponding author Valentin Fuster, MD, Ph.D., Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital, in a release. “Using anticoagulants should be considered when patients get admitted to the ER and have tested positive for COVID-19 to possibly improve outcomes. However, each case should be evaluated on an individualized basis to account for potential bleeding risk.”

Blood thinners with In-Hospital Survival Among Hospitalized Patients with COVID-19

“As a cardiologist who has been on service caring for COVID-19 patients for the last three weeks, I have observed an increased amount of blood clot cases among hospitalized patients, so it is critical to look at whether anticoagulants provide benefits for them,” explained co-researcher Anu Lala, MD, Assistant Professor of Medicine (Cardiology) at the Icahn School of Medicine at Mount Sinai. “It’s important to note that further analysis and prospective studies are required to determine the effectiveness of widespread use of anticoagulants in hospitalized COVID-19 patients.”

Anticoagulants (AC), like aspirin, heparin, or warfarin, reduce the development of clots by preventing blood cells known as platelets from clumping together. 

As COVID-19 progresses, its genetic material comprises more and more vital bio-operations. Without intervention, this process can lead to acute respiratory distress syndrome or multiple organ failure. 

All of the participants involved in the new study were treated at an NYC-based Mount Sinai Health System between March 14th and April 11th, 2020. 

Even after the researchers adjusted for relevant health factors like age, lifestyle choices, diet, ethnicity, and pre-existing health conditions, blood thinners yielded a major influence on case severity and survival rates in both ICU and non-ICU scenarios.

“The novel coronavirus 2019 (COVID-19) has affected nearly every country worldwide. Reports note increased thromboembolic events among hospitalized patients and anecdotal observations of improved outcomes with systemic anticoagulation. However the specific role of AC in disease management remains unclear,” the authors wrote in the new paper. “Among 2,773 hospitalized COVID-19 patients, 786 (28%) received systemic AC during their hospital course. The median hospitalization duration was 5 days (3-8 days). Median time from admission to AC initiation was 2 days (0-5 days). The Median (IQR) duration of AC treatment was 3 days (2-7 days). In-hospital mortality for patients treated with AC was 22.5% with a median survival of 21 days, compared to 22.8% and median survival of 14 days in patients who did not receive AC

These findings were also consistent among patients who succumbed to the respiratory illness; with the median living longer than they would have otherwise. These patients survived an average of 21 days longer after being treated with blood thinners. 

Additionally, blood thinners improved the outcomes for patients placed on ventilators. Sixty-two percent of ventilated patients who did not receive blood thinners passed away, while only 29.1% of ventilated patients who were given blood thinners died.

Bleeding events, like peptic ulcers with hemorrhage, colon, rectal, or anal hemorrhages, and acute hemorrhagic gastritis, dually declined as a result of AC treatment.

Among those who did not receive AC, 38 individuals suffered bleeding events, compared to 24 (3%) among those who did receive AC. Of the 24 patients who had bleeding events while taking AC, 15 (63%) had bleeding events after starting AC and 9 (37%) had bleeding events before starting AC. All of these outcomes were more compounded among patients intubated compared to non-intubated patients.

These numbers warrant more research, but even still no one supportive measure will operate alone.  In the time since SARS-CoV-2 achieved pandemic status, researchers have a better idea about its pathology and our adaptive immune system’s response to it. 

It’s only a matter of time before health systems will regain the capacity to suppress transmission rates, and curb fatalities. 

“We are hopeful that this report of the association of anticoagulation therapy with improved survival will be confirmed in future investigations. The astute scientists at Mount Sinai continue to analyze our data on COVID-19 patients in order to contribute to worldwide efforts to find effective treatments,” comments David Reich, MD, President and Chief Operating Officer of The Mount Sinai Hospital.

CW Headley is a reporter for the Ladders and can be reached at cheadley@theladders.com