J Hematol . Incidence of Venous Thromboembolism in Hospitalized COVID-19 Patients Receiving Thromboprophylaxis

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J Hematol


. 2022 Oct;11(5):167-175.
doi: 10.14740/jh1036. Epub 2022 Oct 31.
Incidence of Venous Thromboembolism in Hospitalized COVID-19 Patients Receiving Thromboprophylaxis


Jimmy Huang ¹ , Jenny Martinez ¹ , Daniel Diaz ¹ , William R Wolowich ²



Affiliations

• PMID: 36406832
• PMCID: PMC9635799
• DOI: 10.14740/jh1036

Abstract

Background: The purpose of this study was to investigate the association between anticoagulant dosing intensity in coronavirus disease 2019 (COVID-19) infected patients and its outcomes on venous thromboembolism (VTE) and all-cause mortality.
Methods: This is a retrospective observational study that examined different anticoagulation regimens among COVID-19 patients for prophylaxis of VTE. Primary outcomes of the study were VTE incidence and all-cause mortality for patients receiving prophylaxis-intensity (PPX) and therapeutic-intensity (TX) anticoagulation. Secondary outcomes were incidence of hemorrhagic events and hospital length of stay. Patients were matched (1:1) based on age and Charlson comorbidity score. Sub-group analyses evaluated outcomes within critically ill patients, between specific anticoagulant agents and comorbid conditions.
Results: The primary outcome of VTE occurred in six patients within the prophylactic dose group and eight patients in the therapeutic-intensity dose group (risk ratio (RR): 2.02 (95% confidence interval (CI): 0.7 - 5.2); P = 0.2). Bleeding occurred in 15 (11%) patients in the prophylactic group and 27 (19%) patients in the therapeutic group (RR: 0.5 (95% CI: 0.3 - 1.0); P < 0.049). Hospital length of stay was shorter by 4 days in those treated with prophylactic-intensity anticoagulation (P = 0.003). Intensive care unit admission and ventilation were negatively correlated with mortality in a multivariate analysis.
Conclusions: Among hospitalized COVID-19 patients, the use of therapeutic-intensity anticoagulation did not show any benefits in reducing the occurrence of VTE. An increase in mortality and in the incidence of hemorrhagic events was statistically significant in the therapeutic-intensity group. Future prospective studies are warranted to evaluate anticoagulation therapy in COVID-19 infected patients.

Keywords: Anticoagulation; COVID-19; Coagulopathy; Coronavirus; D-dimer; Heparin; Low-molecular-weight heparin; SARS.