Riskier Blood Thinner Used More Often In Black Patients; Psychiatric Issues Linked To COVID-19
A new analysis of the use of blood thinners in hospitalized COVID-19 patients highlights a striking racial disparity that may help further explain why Black patients are hit harder by the disease. The anticoagulant enoxaparin – sold under the brand name Lovenox – which is associated with superior COVID-19 outcomes, is more likely to be given to Caucasian patients. Unfractionated heparin, an alternative drug associated with more complications, is more likely to be given to Black patients, according to data from over 25,000 hospitalized COVID-19 patients in the international Discovery VIRUS registry. Treatment with unfractionated heparin was tied to more kidney injuries, heart injuries, life threatening blood infections, and anemia. Black patients were 28% more likely than Caucasians to receive heparin, the analysis found. Mortality rates were 41% in patients who got unfractionated heparin and 15% in patients administered enoxaparin, researchers reported on Tuesday on medRxiv ahead of peer review. Despite the availability of generic enoxaparin, it still remains more expensive than heparin, said coauthor Venky Soundararajan of nference, a Massachusetts data analytics company. As the study cannot prove causality, Soundararajan’s team calls for rigorous research to elucidate the socioeconomic, racial, or other disparities that underlie their findings. (https://bit.ly/2ItsXnM)
Compared to patients recovering from other medical conditions, COVID-19 survivors are at greater risk of developing mental health problems, most commonly anxiety, depression and insomnia, psychiatrists reported on Monday. The estimated incidence of a first psychiatric diagnosis within 90 days was 5.8% among COVID-19 survivors, compared to 2.8% in a comparison group of flu survivors, 3.2% in patients recovering from gallstones, and 2.5% in patients who had suffered fractures. The study, published in The Lancet Psychiatry, included more than 62,000 U.S. COVID-19 patients, about two-thirds of whom had never been diagnosed with a psychiatric illness. Mental health specialists not directly involved with the study said the findings add to growing evidence that COVID-19 can affect the brain and mind, increasing the risk of a range of psychiatric illnesses. “This is likely due to a combination of the psychological stressors associated with this particular pandemic and the physical effects of the illness,” said Michael Bloomfield, a consultant psychiatrist at University College London. (https://bit.ly/32z1bh3; https://reut.rs/2Iv5oeG)
Prone positioning, or lying face down, might be useful for severely ill COVID-19 patients who can still breathe on their own, early data suggest. Lying face down makes it easier for the lungs to deliver oxygen to the blood. The position is often used in COVID-19 patients on mechanical ventilators, but it is not without risks. Until the pandemic, it was not used in patients who were not intubated, even if they had low oxygen levels. In a report on Wednesday in CMAJ, researchers say evidence is emerging that hospitalized COVID-19 patients who are awake and breathing on their own might benefit. Their review of published data found that studies so far have been small, and randomized trials are needed to clarify the benefits and risks in COVID-19 patients, they advise. Earlier this year, Dr. Sanja Jelic of Columbia University Medical Center told Reuters she would not recommend prone positioning at home. “Lay people may not be able to assess accurately whether somebody has altered mental status or is too weak for this maneuver,” she said. “Patients need to have intact mental status and be able to turn themselves in bed without assistance. Being in prone position while confused or lethargic may increase the risk for aspiration and possibly worsen already low oxygen levels.” (https://bit.ly/32C5KY1)
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