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Clinical outcome with different doses of low-molecular-weight heparin in patients hospitalized for COVID-19

2021; Springer Science+Business Media; Volume: 52; Issue: 3 Linguagem: Inglês

10.1007/s11239-021-02401-x

1573-742X

Marco Mennuni, Giulia Renda, Leonardo Grisafi, Andrea Rognoni, Crizia Colombo, Veronica Lio, Melissa Foglietta, Ivan Petrilli, Mario Pirisi, Enrico Guido Spinoni, Danila Azzolina, Eyal Hayden, Luca Lorenzini, Gian Carlo Avanzi, Mattia Bellan, Vincenzo Cantaluppi, Andrea Capponi, Luigi Mario Castello, Damiano D’Ardes, Françesco Della Corte, Sabina Gallina, Marco Krengli, Mario Malerba, Sante D. Pierdomenico, Paola Savoia, Patrizia Zeppegno, Pier Paolo Sainaghi, Francesco Cipollone, Giuseppe Patti,

Sepsis Diagnosis and Treatment

Abstract A pro-thrombotic milieu and a higher risk of thrombotic events were observed in patients with CoronaVirus disease-19 (COVID-19). Accordingly, recent data suggested a beneficial role of low molecular weight heparin (LMWH), but the optimal dosage of this treatment is unknown. We evaluated the association between prophylactic vs. intermediate-to-fully anticoagulant doses of enoxaparin and in-hospital adverse events in patients with COVID-19. We retrospectively included 436 consecutive patients admitted in three Italian hospitals. Outcome according to the use of prophylactic (4000 IU) vs. higher (> 4000 IU) daily dosage of enoxaparin was evaluated. The primary end-point was in-hospital death. Secondary outcome measures were in-hospital cardiovascular death, venous thromboembolism, new-onset acute respiratory distress syndrome (ARDS) and mechanical ventilation. A total of 287 patients (65.8%) were treated with the prophylactic enoxaparin regimen and 149 (34.2%) with a higher dosing regimen. The use of prophylactic enoxaparin dose was associated with a similar incidence of all-cause mortality (25.4% vs. 26.9% with the higher dose; OR at multivariable analysis, including the propensity score: 0.847, 95% CI 0.400–0.1.792; p = 0.664). In the prophylactic dose group, a significantly lower incidence of cardiovascular death (OR 0.165), venous thromboembolism (OR 0.067), new-onset ARDS (OR 0.454) and mechanical intubation (OR 0.150) was observed. In patients hospitalized for COVID-19, the use of a prophylactic dosage of enoxaparin appears to be associated with similar in-hospital overall mortality compared to higher doses. These findings require confirmation in a randomized, controlled study.