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Intermediate- vs. Standard-Dose Prophylactic Anticoagulation in Patients With COVID-19 Admitted in Medical Ward: A

David M Smadja1,2,3, Guillaume Bonnet4,5, Nicolas Gendron1,2

  • 1Innovative Therapies in Haemostasis, INSERM, Université de Paris, Paris, France.

Frontiers in Medicine
|November 1, 2021
PubMed

Insights

Intermediate-dose prophylactic anticoagulation (AC) did not significantly reduce in-hospital mortality in COVID-19 patients compared to standard-dose AC. This study found no difference in mortality or thrombotic events between the two anticoagulant regimens.

Area of Science:

  • * Internal Medicine
  • * Critical Care Medicine
  • * Pharmacology

Background:

  • * Microthrombosis and large-vessel thrombosis are key factors in COVID-19 severity.
  • * The optimal anticoagulant strategy for hospitalized COVID-19 patients remains undetermined.
  • * This study addresses the need for evidence-based anticoagulant regimens in non-ICU COVID-19 patients.

Purpose of the Study:

  • * To compare the efficacy of intermediate-dose versus standard-dose prophylactic anticoagulation.
  • * To evaluate the impact on in-hospital mortality and thrombotic events in COVID-19 patients.
  • * To determine the optimal anticoagulant regimen for hospitalized COVID-19 patients in medical wards.

Main Methods:

  • * A retrospective analysis of 2,878 COVID-19 patients hospitalized in French medical wards.
  • * Propensity-score matching was used to create comparable cohorts for intermediate-dose (n=261) and standard-dose (n=763) prophylactic anticoagulation.
  • * In-hospital mortality and thrombotic events were the primary and secondary outcomes, respectively.

Main Results:

  • * In-hospital mortality rates were similar: 8.8% for intermediate-dose AC and 9.4% for standard-dose AC (p=0.85).
  • * Time to death was comparable between groups (11.5 vs. 11.6 days, p=0.17).
  • * No significant differences were observed in venous or arterial thrombotic events between the two AC doses.

Conclusions:

  • * Intermediate-dose prophylactic anticoagulation offers no significant mortality benefit over standard-dose prophylactic anticoagulation in hospitalized COVID-19 patients.
  • * The study found no significant difference in thrombotic events between the two prophylactic anticoagulation strategies.
  • * Current evidence suggests standard-dose prophylactic anticoagulation is sufficient for hospitalized COVID-19 patients in medical wards.

Keywords:
COVID-19LMWHSARS-CoV-2anticoagulationintermediate dosemortalityprophylactic treatment

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