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J Thromb Thrombolysis
. 2021 Mar 1.
doi: 10.1007/s11239-021-02401-x. Online ahead of print.
Clinical outcome with different doses of low-molecular-weight heparin in patients hospitalized for COVID-19
Marco G Mennuni 1 , Giulia Renda 2 3 , Leonardo Grisafi 1 4 , Andrea Rognoni 1 , Crizia Colombo 1 4 , Veronica Lio 1 4 , Melissa Foglietta 2 3 , Ivan Petrilli 2 3 , Mario Pirisi 1 4 , Enrico Spinoni 1 4 , Danila Azzolina 4 , Eyal Hayden 1 4 , Gianluca Aimaretti 1 4 , Gian Carlo Avanzi 1 4 , Mattia Bellan 1 4 , Vincenzo Cantaluppi 1 4 , Andrea Capponi 1 , Luigi M Castello 1 4 , Damiano D'Ardes 2 3 , Francesco Della Corte 1 4 , Sabina Gallina 2 3 , Marco Krengli 1 4 , Mario Malerba 4 5 , Sante D Pierdomenico 2 3 , Paola Savoia 1 4 , Patrizia Zeppegno 1 4 , Pier P Sainaghi 1 4 , Francesco Cipollone 2 3 , Giuseppe Patti 6 7 , COVID-UPO Clinical Team
Affiliations
- PMID: 33649979
- DOI: 10.1007/s11239-021-02401-x
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.
Keywords: COVID-19; Enoxaparin doses; Mortality; Thromboprophylaxis.