Treatments Associated with Lower Mortality among Critically Ill COVID-19 Patients: A Retrospective Cohort Study
M.D Xu Zhao, M.D Chan Gao, Ph.D Feng Dai, Ph.D Miriam M Treggiari, M.P.H Ranjit Deshpande, F.C.C.M Lingzhong Meng
Anesthesiology, doi:10.1097/aln.0000000000003999
What We Already Know about This Topic • While the treatment of critically ill COVID-19 patients has improved, mortality rates remain high What This Article Tells Us That Is New • In a retrospective cohort consisting of 2,070 critically ill COVID-19 patients treated in six hospitals, multivariable regression analysis showed lower in-hospital mortality associated with apixaban, aspirin, or enoxaparin treatment • Propensity score-matching analyses demonstrated lower mortality for patients receiving apixaban (27% [96 of 360] vs. 37% [133 of 360]), aspirin (26% [121 of 473] vs. 30% [140 of 473]), or enoxaparin (25% [87 of 347) vs. 34% [117 of 347]) compared to matched controls A Particular challenge of COVID-19 treatment is the high mortality, especially among critically ill patients. Although the mortality rate was estimated to be ~50% among critically ill COVID-19 patients in the early stage of the pandemic, 1 a study performed at a later stage of the pandemic showed a downward trend of mortality rates from ~44% to ~19%. 2 Effective treatments might be one factor responsible for this decline. Continuous efforts in discovering effective treatments are needed and have been ongoing as evidenced by the recent trials exploring the effectiveness of therapeutic versus prophylactic anticoagulation in hospitalized and critically ill patients. [3] [4] [5] With the passing of the COVID-19 pandemic's first anniversary and the surge of the Delta variant, a look back at the data accumulated over 1 yr provides an opportunity to identify potentially effective treatments. Such an approach could corroborate established treatments or generate hypotheses for future investigations. This retrospective cohort study hypothesized that certain treatments would be associated with lower mortality in patients
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