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75. Systemic Anticoagulation Use Is Independently Associated with Lower Mortality in Hospitalized COVID-19 Patients with D-dimer Level Higher Than 5 Mcg/ml

Background: Elevated D-dimer level is frequently seen in patients with COVID-19 and is associated with worse clinical outcomes The potential benefit of systemic anticoagulation in COVID-19 has been suggested, but data lack on when to initiate anticoagulation We aimed to identify a cut-off value of D-dimer at which anticoagulation may provide mortality benefit in COVID-19 Methods: A retrospective review was conducted for a cohort of patients hospitalized with COVID-19 at a 262-bed community hospital in a Washington D C suburb Patients hospitalized between April 1, 2020, and April 30, 2020, with laboratory-confirmed COVID-19 were included if d-dimer levels were checked during hospitalization Demographics, laboratory results, and hospital courses were reviewed Logistic regression was used to examine the association between anticoagulation and in-hospital mortality, controlling for the d-dimer value The association was examined in subgroups with different d-dimer cut-offs Multivariable logistic regression models were developed to assess if the association between anticoagulation and mortality remains after adjusting for other mortality risk factors Results: 101 patients were included in the study and 32 (31 7%) died during hospitalization The average age was 61 2 ± 14 8 years old and 50 5% were males Older age, male sex, hypertension, and peak d-dimer level were associated with mortality in univariable analysis (p3mcg/mL, anticoagulation use was associated with lower mortality after controlling for the d-dimer level (OR 0 25, 95% CI 0 06-0 97 p=0 045) This association weakened after adjusting for age, sex, and hypertension (OR 0 33, 95% CI 0 07-1 46, p=0 143) For patients with peak d-dimer level >5 mcg/mL, anticoagulation use was associated with lower mortality after controlling for the d-dimer level (OR 0 11, 95% CI 0 02-0 68, p=0 017) and this association remained significant after adjusting for age, sex, and hypertension (OR 0 11, 95% CI 0 01-0 86, p=0 035) Conclusion: In hospitalized COVID-19 patients with a d-dimer level higher than 5 mcg/mL, anticoagulation use was independently associated with lower mortality