tetano
Editor, Senior Moderator
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[SUP] 1 [/SUP], Giulia Renda[SUP] 2 3 [/SUP], Leonardo Grisafi[SUP] 1 4 [/SUP], Andrea Rognoni[SUP] 1 [/SUP], Crizia Colombo[SUP] 1 4 [/SUP], Veronica Lio[SUP] 1 4 [/SUP], Melissa Foglietta[SUP] 2 3 [/SUP], Ivan Petrilli[SUP] 2 3 [/SUP], Mario Pirisi[SUP] 1 4 [/SUP], Enrico Spinoni[SUP] 1 4 [/SUP], Danila Azzolina[SUP] 4 [/SUP], Eyal Hayden[SUP] 1 4 [/SUP], Gianluca Aimaretti[SUP] 1 4 [/SUP], Gian Carlo Avanzi[SUP] 1 4 [/SUP], Mattia Bellan[SUP] 1 4 [/SUP], Vincenzo Cantaluppi[SUP] 1 4 [/SUP], Andrea Capponi[SUP] 1 [/SUP], Luigi M Castello[SUP] 1 4 [/SUP], Damiano D'Ardes[SUP] 2 3 [/SUP], Francesco Della Corte[SUP] 1 4 [/SUP], Sabina Gallina[SUP] 2 3 [/SUP], Marco Krengli[SUP] 1 4 [/SUP], Mario Malerba[SUP] 4 5 [/SUP], Sante D Pierdomenico[SUP] 2 3 [/SUP], Paola Savoia[SUP] 1 4 [/SUP], Patrizia Zeppegno[SUP] 1 4 [/SUP], Pier P Sainaghi[SUP] 1 4 [/SUP], Francesco Cipollone[SUP] 2 3 [/SUP], Giuseppe Patti[SUP] 6 7 [/SUP], COVID-UPO Clinical Team
Affiliations
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.
. 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[SUP] 1 [/SUP], Giulia Renda[SUP] 2 3 [/SUP], Leonardo Grisafi[SUP] 1 4 [/SUP], Andrea Rognoni[SUP] 1 [/SUP], Crizia Colombo[SUP] 1 4 [/SUP], Veronica Lio[SUP] 1 4 [/SUP], Melissa Foglietta[SUP] 2 3 [/SUP], Ivan Petrilli[SUP] 2 3 [/SUP], Mario Pirisi[SUP] 1 4 [/SUP], Enrico Spinoni[SUP] 1 4 [/SUP], Danila Azzolina[SUP] 4 [/SUP], Eyal Hayden[SUP] 1 4 [/SUP], Gianluca Aimaretti[SUP] 1 4 [/SUP], Gian Carlo Avanzi[SUP] 1 4 [/SUP], Mattia Bellan[SUP] 1 4 [/SUP], Vincenzo Cantaluppi[SUP] 1 4 [/SUP], Andrea Capponi[SUP] 1 [/SUP], Luigi M Castello[SUP] 1 4 [/SUP], Damiano D'Ardes[SUP] 2 3 [/SUP], Francesco Della Corte[SUP] 1 4 [/SUP], Sabina Gallina[SUP] 2 3 [/SUP], Marco Krengli[SUP] 1 4 [/SUP], Mario Malerba[SUP] 4 5 [/SUP], Sante D Pierdomenico[SUP] 2 3 [/SUP], Paola Savoia[SUP] 1 4 [/SUP], Patrizia Zeppegno[SUP] 1 4 [/SUP], Pier P Sainaghi[SUP] 1 4 [/SUP], Francesco Cipollone[SUP] 2 3 [/SUP], Giuseppe Patti[SUP] 6 7 [/SUP], 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.