Drug prescription patterns and their association with mortality and hospitalization duration in COVID-19 patients: insights from big data
Reza Mehrizi, Ali Golestani, Mohammad-Reza Malekpour, Hossein Karami, Mohammad Mahdi Nasehi, Mohammad Effatpanah, Hossein Ranjbaran, Zahra Shahali, Ali Akbari Sari, Rajabali Daroudi
Frontiers in Public Health, doi:10.3389/fpubh.2023.1280434
Background: Different medication prescription patterns have been associated with varying course of disease and outcomes in COVID-19. Health claims data is a rich source of information on disease treatment and outcomes. We aimed to investigate drug prescription patterns and their association with mortality and hospitalization via insurance data for a relatively long period of the pandemic in Iran.
Methods: We retrieved hospitalized patients' data from Iran Health Insurance Organization (IHIO) spanning 26 months (2020-2022) nationwide. Included were patients with ICD-10 codes U07.1/U07.2 for confirmed/suspected COVID-19. A case was defined as a single hospitalization event for an individual patient. Multiple hospitalizations of a patient within a 30-day interval were aggregated into a single case, while hospitalizations with intervals exceeding 30 days were treated as independent cases. The Anatomical Therapeutic Chemical (ATC) was used for medications classification. The two main study outcomes were general and intensive care unit (ICU) hospitalization periods and mortality. Besides, various demographic and clinical associate factors were analyzed to derive the associations with medication prescription patterns and study outcomes using accelerated failure time (AFT) and logistic regression models. Results: During the 26 months of the study period, 1,113,678 admissions with COVID-19 diagnosis at hospitals working in company with IHIO were recorded. 917,198 cases were detected from the database, among which 51.91% were females and 48.09% were males. Among the main groups of medications, antithrombotics (55. ), corticosteroids (54.14% [54.04-54.24]), and antibiotics (42.22% [42.12-42.32]) were the top used medications among cases with COVID-19. Investigation of the duration of hospitalization based on main medication groups showed antithrombotics (adjusted median ratio = 0.94 [0.94-0.95]) were significantly associated with shorter periods of overall hospitalization. Also, antithrombotics (adjusted odds ratio = 0.74 [95%CI,
Ethics statement This study was approved by the ethical committee at the School of Public Health, Tehran University of Medical Sciences (code: IR.TUMS. SPH.REC.1401.120). The provided data by IHIO in this study were de-identified and data holder and study investigators were responsible to save the privacy of the patients and users of the IHIO insurance services. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation was not required from the participants or the participants' legal guardians/next of kin in accordance with the national legislation and institutional requirements.
Author contributions
Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Supplementary material The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2023.1280434/ full#supplementary-material
References
Abbasi-Kangevari, Ghanbari, Malekpour, Ghamari, Azadnajafabad et al., Exploring the clinical benefit of ventilation therapy across various patient groups with COVID-19 using real-world data, Sci Rep,
doi:10.1038/s41598-023-37912-5Azadnajafabad, Ghasemi, Moghaddam, Rezaei, Farzadfar, Noncommunicable Diseases' contribution to the COVID-19 mortality: a global warning on the emerging Syndemics, Arch Iran Med,
doi:10.34172/aim.2021.63Azadnajafabad, Moghaddam, Rezaei, Ghasemi, Naderimagham et al., A report on statistics of an online self-screening platform for COVID-19 and its effectiveness in Iran, Int J Health Policy Manag,
doi:10.34172/ijhpm.2020.252Bansal, Mahapure, Bhurwal, Gupta, Hassanain et al., Mortality benefit of Remdesivir in COVID-19: a systematic review and meta-analysis, Front Med,
doi:10.3389/fmed.2020.606429Beigel, Tomashek, Dodd, Mehta, Zingman et al., Remdesivir for the treatment of Covid-19, N Engl J Med,
doi:10.1056/NEJMoa2007764Best, Kong, Kaplan-Lewis, Brawley, Baden et al., Treatment patterns in US patients hospitalized with COVID-19 and pulmonary involvement, J Med Virol,
doi:10.1002/jmv.27049Biswas, Rahaman, Biswas, Haque, Association of sex, age, and comorbidities with mortality in COVID-19 patients: a systematic review and metaanalysis, Intervirology,
doi:10.1159/000512592Castelnuovo, Costanzo, Antinori, Berselli, Blandi et al., Heparin in COVID-19 patients is associated with reduced in-hospital mortality: the multicenter Italian CORIST study, Thromb Haemost,
doi:10.1055/a-1347-6070Damiri, Shojaee, Dehghani, Shahali, Abbasi et al., National geographical pattern of COVID-19 hospitalization, case fatalities, and associated factors in patients covered by Iran health insurance organization, BMC Public Health,
doi:10.1186/s12889-022-13649-0Davari, Haycox, Walley, The Iranian health insurance system; past experiences, present challenges and future strategies, Iran J Public Health
Ebrahimoghli, Janati, Sadeghi-Bazargani, Hamishehkar, Chronic diseases and multimorbidity in Iran: a study protocol for the use of Iranian health insurance organization's claims database to understand epidemiology, health service utilization, and patient costs, Health Services Outcomes Res Methodol,
doi:10.1007/s10742-020-00232-6Fang, Karakiulakis, Roth, Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?, Lancet Respir Med,
doi:10.1016/S2213-2600(20)30116-8Ghosh, Bornman, Zafer, Antimicrobial resistance threats in the emerging COVID-19 pandemic: where do we stand?, J Infect Public Health,
doi:10.1016/j.jiph.2021.02.011Gyselinck, Janssens, Verhamme, Vos, Rationale for azithromycin in COVID-19: an overview of existing evidence, BMJ open. Respir Res,
doi:10.1136/bmjresp-2020-000806Hashemi-Meshkini, Koochak, Nikfar, Rezaei-Darzi, Yaghoubifard, Evaluation of COVID-19 treatments in Iran in comparison with local therapeutic recommendations: a population-level study on utilization and costs of prescription drugs, J Res Pharmacy Pract,
doi:10.4103/jrpp.jrpp_6_22Heidari, Sayfouri, Jafari, Consecutive waves of COVID-19 in Iran: various dimensions and probable causes, Disaster Med Public Health Prep,
doi:10.1017/dmp.2022.141Jeon, Seon, Park, Oh, Analysis of risk factors on readmission cases of COVID-19 in the Republic of Korea: using Nationwide health claims data, Int J Environ Res Public Health,
doi:10.3390/ijerph17165844Keykhaei, Koolaji, Mohammadi, Kalantar, Moghaddam et al., Dissection of non-pharmaceutical interventions implemented by Iran, South Korea, and Turkey in the fight against COVID-19 pandemic, J Diabetes Metab Disord,
doi:10.1007/s40200-021-00877-1Levy, Iba, Olson, Corey, Ghadimi et al., COVID-19: thrombosis, thromboinflammation, and anticoagulation considerations, Int J Lab Hematol,
doi:10.1111/ijlh.13500Li, Yang, Yan, Sun, Zeng et al., Metformin in patients with COVID-19: a systematic review and meta-analysis, Front Med,
doi:10.3389/fmed.2021.809134Liu, Wen, Lei, Jiang, Clinical characteristics and antibiotics treatment in suspected bacterial infection patients with COVID-19, Int Immunopharmacol,
doi:10.1016/j.intimp.2020.107157Malekpour, Abbasi-Kangevari, Shojaee, Moghaddam, Ghamari et al., Effect of the chronic medication use on outcome measures of hospitalized COVID-19 patients: evidence from big data, Front Public Health,
doi:10.3389/fpubh.2023.1061307Mattos-Silva, Felix, Silva, Robba, Battaglini et al., Pros and cons of corticosteroid therapy for COVID-19 patients, Respir Physiol Neurobiol,
doi:10.1016/j.resp.2020.103492Mehta, An, Andersen, Mansour, Madhira et al., Use of hydroxychloroquine, remdesivir, and dexamethasone among adults hospitalized with COVID-19 in the United States: a retrospective cohort study, Ann Intern Med,
doi:10.7326/M21-0857Meng, Xiao, Zhang, He, Ou et al., Renin-angiotensin system inhibitors improve the clinical outcomes of COVID-19 patients with hypertension, Emerg Microbes Infect,
doi:10.1080/22221751.2020.1746200Mustafa, Kow, Salman, Kanwal, Riaz et al., Pattern of medication utilization in hospitalized patients with COVID-19 in three District Headquarters hospitals in the Punjab province of Pakistan, Explor Res Clin Soc Pharm,
doi:10.1016/j.rcsop.2021.100101Ortiz-Prado, Izquierdo-Condoy, Mora, Vasconez-Gonzalez, Fernandez-Naranjo, Poor regulation, desperation, and misinformation, a countrywide analysis of self-medication and prescription patterns in Ecuador during the COVID-19 pandemic, Res Soc Adm Pharm,
doi:10.1016/j.sapharm.2023.08.011Pilia, Belletti, Fresilli, Finco, Landoni, Efficacy and safety of heparin full-dose anticoagulation in hospitalized non-critically ill COVID-19 patients: a metaanalysis of multicenter randomized controlled trials, J Thromb Thrombolysis,
doi:10.1007/s11239-022-02681-xPilia, Belletti, Fresilli, Lee, Zangrillo et al., The effect of heparin full-dose anticoagulation on survival of hospitalized, non-critically ill COVID-19 patients: a meta-analysis of high quality studies, Lung,
doi:10.1007/s00408-023-00599-6Pinte, Ceasovschih, Niculae, Stoichitoiu, Ionescu et al., Antibiotic prescription and in-hospital mortality in COVID-19: a prospective multicentre cohort study, J Pers Med,
doi:10.3390/jpm12060877Qian, Li, Peng, Gao, Cai et al., Association between hypertension and prognosis of patients with COVID-19: a systematic review and meta-analysis, Clin Exp Hypertens,
doi:10.1080/10641963.2022.2071914Sieswerda, De Boer, Bonten, Boersma, Jonkers et al., Recommendations for antibacterial therapy in adults with COVID-19 -an evidence based guideline, Clin Microbiol Infect,
doi:10.1016/j.cmi.2020.09.041Sivaloganathan, Ladikou, Chevassut, COVID-19 mortality in patients on anticoagulants and antiplatelet agents, Br J Haematol,
doi:10.1111/bjh.16968Sultana, Cutroneo, Crisafulli, Puglisi, Caramori et al., Azithromycin in COVID-19 patients: pharmacological mechanism, clinical evidence and prescribing guidelines, Drug Saf,
doi:10.1007/s40264-020-00976-7Valladales-Restrepo, Correa, Bs, Constain-Mosquera, Sabogal-Ortiz et al., Prescription patterns of drugs given to hospitalized COVID-19 patients: a cross-sectional study in Colombia, Antibiotics,
doi:10.3390/antibiotics11030333Wallace, Cirillo, Ryan, Krigbaum, Badathala et al., Association of the patterns of use of medications with mortality of COVID-19 infection: a hospital-based observational study, BMJ Open,
doi:10.1136/bmjopen-2021-050051Wijaya, Andhika, Huang, The use of therapeutic-dose anticoagulation and its effect on mortality in patients with COVID-19: a systematic review, Clin Appl Thromb Hemost,
doi:10.1177/1076029620960797Wise, Covid-19: WHO declares end of global health emergency
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'abstract': '<jats:sec><jats:title>Background</jats:title><jats:p>Different medication prescription '
'patterns have been associated with varying course of disease and outcomes in COVID-19. Health '
'claims data is a rich source of information on disease treatment and outcomes. We aimed to '
'investigate drug prescription patterns and their association with mortality and '
'hospitalization via insurance data for a relatively long period of the pandemic in '
'Iran.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We retrieved '
'hospitalized patients’ data from Iran Health Insurance Organization (IHIO) spanning 26\u2009'
'months (2020–2022) nationwide. Included were patients with ICD-10 codes U07.1/U07.2 for '
'confirmed/suspected COVID-19. A case was defined as a single hospitalization event for an '
'individual patient. Multiple hospitalizations of a patient within a 30-day interval were '
'aggregated into a single case, while hospitalizations with intervals exceeding 30\u2009days '
'were treated as independent cases. The Anatomical Therapeutic Chemical (ATC) was used for '
'medications classification. The two main study outcomes were general and intensive care unit '
'(ICU) hospitalization periods and mortality. Besides, various demographic and clinical '
'associate factors were analyzed to derive the associations with medication prescription '
'patterns and study outcomes using accelerated failure time (AFT) and logistic regression '
'models.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>During the '
'26\u2009months of the study period, 1,113,678 admissions with COVID-19 diagnosis at hospitals '
'working in company with IHIO were recorded. 917,198 cases were detected from the database, '
'among which 51.91% were females and 48.09% were males. Among the main groups of medications, '
'antithrombotics (55.84% [95% CI: 55.74–55.94]), corticosteroids (54.14% [54.04–54.24]), and '
'antibiotics (42.22% [42.12–42.32]) were the top used medications among cases with COVID-19. '
'Investigation of the duration of hospitalization based on main medication groups showed '
'antithrombotics (adjusted median ratio\u2009=\u20090.94 [0.94–0.95]) were significantly '
'associated with shorter periods of overall hospitalization. Also, antithrombotics (adjusted '
'odds ratio\u2009=\u20090.74 [95%CI, 0.73–0.76]), corticosteroids (0.97 [0.95–0.99]), '
'antivirals (0.82 [0.80–0.83]), and ACE inhibitor/ARB (0.79 [0.77–0.80]) were significantly '
'associated with lower '
'mortality.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Over '
'2\u2009years of investigation, antithrombotics, corticosteroids, and antibiotics were the top '
'medications for hospitalized patients with COVID-19. Trends in medication prescription varied '
'based on various factors across the country. Medication prescriptions could potentially '
'significantly impact the trends of mortality and hospitalization during epidemics, thereby '
'affecting both health and economic burdens.</jats:p></jats:sec>',
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'reference': [ { 'key': 'ref1',
'volume-title': 'Covid-19: WHO declares end of global health emergency',
'author': 'Wise',
'year': '2023'},
{ 'key': 'ref2',
'doi-asserted-by': 'publisher',
'first-page': '164',
'DOI': '10.1016/j.vacun.2023.05.002',
'article-title': 'The end of COVID-19 public health emergency of international concern '
'(PHEIC): and now what?',
'volume': '24',
'author': 'Torner',
'year': '2023',
'journal-title': 'Vacunas'},
{ 'key': 'ref3',
'doi-asserted-by': 'publisher',
'first-page': '1625',
'DOI': '10.1016/S0140-6736(21)02751-3',
'article-title': 'Health system performance in Iran: a systematic analysis for the global '
'burden of disease study 2019',
'volume': '399',
'year': '2022',
'journal-title': 'Lancet'},
{ 'key': 'ref4',
'doi-asserted-by': 'publisher',
'first-page': '1069',
'DOI': '10.34172/ijhpm.2020.252',
'article-title': 'A report on statistics of an online self-screening platform for '
'COVID-19 and its effectiveness in Iran',
'volume': '11',
'author': 'Azadnajafabad',
'year': '2021',
'journal-title': 'Int J Health Policy Manag'},
{ 'key': 'ref5',
'doi-asserted-by': 'publisher',
'first-page': '445',
'DOI': '10.34172/aim.2021.63',
'article-title': "Non-communicable Diseases' contribution to the COVID-19 mortality: a "
'global warning on the emerging Syndemics',
'volume': '24',
'author': 'Azadnajafabad',
'year': '2021',
'journal-title': 'Arch Iran Med'},
{ 'key': 'ref6',
'doi-asserted-by': 'publisher',
'first-page': '1919',
'DOI': '10.1007/s40200-021-00877-1',
'article-title': 'Dissection of non-pharmaceutical interventions implemented by Iran, '
'South Korea, and Turkey in the fight against COVID-19 pandemic',
'volume': '20',
'author': 'Keykhaei',
'year': '2021',
'journal-title': 'J Diabetes Metab Disord'},
{ 'key': 'ref7',
'doi-asserted-by': 'publisher',
'first-page': 'e136',
'DOI': '10.1017/dmp.2022.141',
'article-title': 'Consecutive waves of COVID-19 in Iran: various dimensions and probable '
'causes',
'volume': '17',
'author': 'Heidari',
'year': '2022',
'journal-title': 'Disaster Med Public Health Prep'},
{ 'key': 'ref8',
'doi-asserted-by': 'publisher',
'first-page': '10747',
'DOI': '10.1038/s41598-023-37912-5',
'article-title': 'Exploring the clinical benefit of ventilation therapy across various '
'patient groups with COVID-19 using real-world data',
'volume': '13',
'author': 'Abbasi-Kangevari',
'year': '2023',
'journal-title': 'Sci Rep'},
{ 'key': 'ref9',
'doi-asserted-by': 'publisher',
'first-page': '263',
'DOI': '10.1017/S0266462300000787',
'article-title': 'Use of insurance claims data in measuring quality of care',
'volume': '6',
'author': 'Lohr',
'year': '1990',
'journal-title': 'Int J Technol Assess Health Care'},
{ 'key': 'ref10',
'doi-asserted-by': 'publisher',
'first-page': '407',
'DOI': '10.1007/s10742-020-00232-6',
'article-title': 'Chronic diseases and multimorbidity in Iran: a study protocol for the '
'use of Iranian health insurance organization’s claims database to '
'understand epidemiology, health service utilization, and patient costs',
'volume': '21',
'author': 'Ebrahimoghli',
'year': '2021',
'journal-title': 'Health Services Outcomes Res Methodol'},
{ 'key': 'ref11',
'doi-asserted-by': 'publisher',
'first-page': '1',
'DOI': '10.4103/jrpp.jrpp_6_22',
'article-title': 'Evaluation of COVID-19 treatments in Iran in comparison with local '
'therapeutic recommendations: a population-level study on utilization '
'and costs of prescription drugs',
'volume': '11',
'author': 'Hashemi-Meshkini',
'year': '2022',
'journal-title': 'J Res Pharmacy Pract'},
{ 'key': 'ref12',
'doi-asserted-by': 'publisher',
'first-page': '1579',
'DOI': '10.1016/j.sapharm.2023.08.011',
'article-title': 'Poor regulation, desperation, and misinformation, a countrywide '
'analysis of self-medication and prescription patterns in Ecuador during '
'the COVID-19 pandemic',
'volume': '19',
'author': 'Ortiz-Prado',
'year': '2023',
'journal-title': 'Res Soc Adm Pharm'},
{ 'key': 'ref13',
'doi-asserted-by': 'publisher',
'first-page': '5844',
'DOI': '10.3390/ijerph17165844',
'article-title': 'Analysis of risk factors on readmission cases of COVID-19 in the '
'Republic of Korea: using Nationwide health claims data',
'volume': '17',
'author': 'Jeon',
'year': '2020',
'journal-title': 'Int J Environ Res Public Health'},
{ 'key': 'ref14',
'doi-asserted-by': 'publisher',
'first-page': '1061307',
'DOI': '10.3389/fpubh.2023.1061307',
'article-title': 'Effect of the chronic medication use on outcome measures of '
'hospitalized COVID-19 patients: evidence from big data',
'volume': '11',
'author': 'Malekpour',
'year': '2023',
'journal-title': 'Front Public Health'},
{ 'key': 'ref15',
'doi-asserted-by': 'publisher',
'first-page': 'e050051',
'DOI': '10.1136/bmjopen-2021-050051',
'article-title': 'Association of the patterns of use of medications with mortality of '
'COVID-19 infection: a hospital-based observational study',
'volume': '11',
'author': 'Wallace',
'year': '2021',
'journal-title': 'BMJ Open'},
{ 'key': 'ref16',
'doi-asserted-by': 'publisher',
'first-page': '100101',
'DOI': '10.1016/j.rcsop.2021.100101',
'article-title': 'Pattern of medication utilization in hospitalized patients with '
'COVID-19 in three District Headquarters hospitals in the Punjab '
'province of Pakistan',
'volume': '5',
'author': 'Mustafa',
'year': '2022',
'journal-title': 'Explor Res Clin Soc Pharm'},
{ 'key': 'ref17',
'doi-asserted-by': 'publisher',
'first-page': '333',
'DOI': '10.3390/antibiotics11030333',
'article-title': 'Prescription patterns of drugs given to hospitalized COVID-19 patients: '
'a cross-sectional study in Colombia',
'volume': '11',
'author': 'Valladales-Restrepo',
'year': '2022',
'journal-title': 'Antibiotics (Basel)'},
{ 'key': 'ref18',
'first-page': '1',
'article-title': 'The Iranian health insurance system; past experiences, present '
'challenges and future strategies',
'volume': '41',
'author': 'Davari',
'year': '2012',
'journal-title': 'Iran J Public Health'},
{'key': 'ref19', 'year': ''}, {'key': 'ref20', 'year': '2019'},
{ 'key': 'ref21',
'doi-asserted-by': 'publisher',
'first-page': '1274',
'DOI': '10.1186/s12889-022-13649-0',
'article-title': 'National geographical pattern of COVID-19 hospitalization, case '
'fatalities, and associated factors in patients covered by Iran health '
'insurance organization',
'volume': '22',
'author': 'Damiri',
'year': '2022',
'journal-title': 'BMC Public Health'},
{'key': 'ref22', 'year': '2023'},
{ 'key': 'ref23',
'volume-title': 'Food and Drug Administration (FDA) 0f Iran - drugs list',
'year': '2023'},
{'key': 'ref24', 'year': '2023'},
{ 'key': 'ref25',
'doi-asserted-by': 'publisher',
'first-page': '1395',
'DOI': '10.7326/M21-0857',
'article-title': 'Use of hydroxychloroquine, remdesivir, and dexamethasone among adults '
'hospitalized with COVID-19 in the United States: a retrospective cohort '
'study',
'volume': '174',
'author': 'Mehta',
'year': '2021',
'journal-title': 'Ann Intern Med'},
{ 'key': 'ref26',
'doi-asserted-by': 'publisher',
'first-page': '5367',
'DOI': '10.1002/jmv.27049',
'article-title': 'Treatment patterns in US patients hospitalized with COVID-19 and '
'pulmonary involvement',
'volume': '93',
'author': 'Best',
'year': '2021',
'journal-title': 'J Med Virol'},
{ 'key': 'ref27',
'doi-asserted-by': 'publisher',
'first-page': '691',
'DOI': '10.1007/s40264-020-00976-7',
'article-title': 'Azithromycin in COVID-19 patients: pharmacological mechanism, clinical '
'evidence and prescribing guidelines',
'volume': '43',
'author': 'Sultana',
'year': '2020',
'journal-title': 'Drug Saf'},
{ 'key': 'ref28',
'doi-asserted-by': 'publisher',
'first-page': 'e000806',
'DOI': '10.1136/bmjresp-2020-000806',
'article-title': 'Rationale for azithromycin in COVID-19: an overview of existing '
'evidence. BMJ open',
'volume': '8',
'author': 'Gyselinck',
'year': '2021',
'journal-title': 'Respir Res'},
{ 'key': 'ref29',
'doi-asserted-by': 'publisher',
'first-page': '155',
'DOI': '10.1016/j.amjcard.2020.08.005',
'article-title': 'The effect of anticoagulation use on mortality in COVID-19 infection',
'volume': '134',
'author': 'Salah',
'year': '2020',
'journal-title': 'Am J Cardiol'},
{ 'key': 'ref30',
'doi-asserted-by': 'publisher',
'first-page': '1054',
'DOI': '10.1055/a-1347-6070',
'article-title': 'Heparin in COVID-19 patients is associated with reduced in-hospital '
'mortality: the multicenter Italian CORIST study',
'volume': '121',
'author': 'Di Castelnuovo',
'year': '2021',
'journal-title': 'Thromb Haemost'},
{ 'key': 'ref31',
'doi-asserted-by': 'publisher',
'first-page': '1076029620960797',
'DOI': '10.1177/1076029620960797',
'article-title': 'The use of therapeutic-dose anticoagulation and its effect on mortality '
'in patients with COVID-19: a systematic review',
'volume': '26',
'author': 'Wijaya',
'year': '2020',
'journal-title': 'Clin Appl Thromb Hemost'},
{ 'key': 'ref32',
'doi-asserted-by': 'publisher',
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'article-title': 'The effect of heparin full-dose anticoagulation on survival of '
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'DOI': '10.3390/jpm12060877',
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'author': 'Pinte',
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'DOI': '10.1016/j.cmi.2020.09.041',
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'article-title': 'Effectiveness of corticosteroids to treat coronavirus disease 2019 '
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'journal-title': 'Med Clin'},
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'DOI': '10.1056/NEJMoa2007764',
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'article-title': 'Mortality benefit of Remdesivir in COVID-19: a systematic review and '
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'volume': '7',
'author': 'Bansal',
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'DOI': '10.1016/S0140-6736(22)00519-0',
'article-title': 'Remdesivir and three other drugs for hospitalised patients with '
'COVID-19: final results of the WHO solidarity randomised trial and '
'updated meta-analyses',
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'journal-title': 'Lancet'},
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'volume': '1',
'author': 'Grundeis',
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'journal-title': 'Cochrane Database Syst Rev'},
{ 'key': 'ref49',
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'DOI': '10.1159/000512592',
'article-title': 'Association of sex, age, and comorbidities with mortality in COVID-19 '
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'author': 'Biswas',
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