Prophylactic versus therapeutic anticoagulation for survival of patients with COVID-19 on steroid

Previous observational and randomized studies suggested potential benefit of therapeutic anticoagulation during hospitalization, but this treatment remains controversial. As of June 30th 2021, steroids is the standard treatment of COVID patients. We aimed to investigate the association of prophylactic and therapeutic anticoagulation with mortality for patients with COVID-19 who were treated with steroids. We retrospectively reviewed the medical records of 2533 patients discharged between March 1st, 2020 and March 30th, 2021, with laboratory-confirmed COVID-19 in the Mount Sinai Health System and treated with steroids. We evaluated the effect of therapeutic versus prophylactic anticoagulation on the outcomes using propensity score analyses. Subgroup analyses were conducted by stratification of patients by endotracheal intubation. Among the 2533 eligible patients, 465 (18.4%) received therapeutic anticoagulation. After 1:1 propensity score matching (N = 383 pairs), in-hospital mortality was similar between those with therapeutic versus prophylactic anticoagulation (36.0% versus 30.0%, P = 0.091). In-hospital mortality regardless of endotracheal intubation were not significantly different between the two groups. Therapeutic anticoagulation was not associated with reduced or increased risk of in-hospital mortality in patients with COVID-19 treated with steroids.