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Comparative Study
. 2021 Oct;52(3):782-790.
doi: 10.1007/s11239-021-02401-x. Epub 2021 Mar 1.

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
Comparative Study

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

Marco G Mennuni et al. J Thromb Thrombolysis. 2021 Oct.

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.

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Conflict of interest statement

All authors have nothing related to this paper to disclose.

Figures

Fig. 1
Fig. 1
Kaplan–Meier estimates of 30-day survival stratified by different doses of enoxaparin
Fig. 2
Fig. 2
Adjusted ORs for the study end-points with prophylactic vs. higher enoxaparin dose. ARDS acute respiratory distress syndrome, CI confidence interval, OR Odds ratio
Fig. 3
Fig. 3
Adjusted ORs for the primary end-point with: 4000 IU vs. > 4000 IU enoxaparin daily dose in the subgroups with low/intermediate and high/very high risk according to the 4C Mortality Score; ≤ 70 IU/Kg vs. > 70 IU/Kg enoxaparin daily regimen. CI Confidence interval; OR Odds ratio
See this image and copyright information in PMC

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