Therapeutic dosing of low-molecular-weight heparin may decrease mortality in patients with severe COVID-19 infection

Area of Science:

• Critical Care Medicine
• Hematology
• Infectious Diseases

Background:

• Severe COVID-19 infection is linked to high rates of venous thromboembolism and mortality.
• Current use of low-molecular-weight heparin (LMWH) for prophylaxis lacks high-quality evidence for optimal dosing.
• There is a need to clarify the relationship between LMWH dosage and patient outcomes in severe COVID-19.

Purpose of the Study:

• To investigate the association between coagulation parameters and LMWH dose.
• To evaluate the impact of LMWH dose on mortality and ICU admission in severe COVID-19 pneumonia patients.

Main Methods:

• Retrospective study conducted at a tertiary care hospital.
• Data collected on clinical features, coagulation, and anticoagulants from 154 inpatients with severe COVID-19.
• Compared outcomes for prophylactic (0.5 mg/kg twice daily) versus therapeutic (1 mg/kg twice daily) LMWH doses.

Main Results:

• Mortality was significantly lower in the therapeutic LMWH group (17.9%) compared to the prophylactic LMWH group (44.9%), P=.001.
• Patients receiving therapeutic LMWH doses had a 6.4-fold lower mortality risk (OR=6.5, 95% CI: 2.4-17.6).
• The study included 98 patients on prophylactic LMWH and 56 on therapeutic LMWH.

Conclusions:

• Therapeutic dosing of LMWH may be associated with reduced mortality in severe COVID-19 pneumonia.
• Higher-dose heparin regimens warrant evaluation in prospective studies for thromboprophylaxis.
• Limitations include a lack of bleeding data and single-center retrospective design.