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Prophylactic anticoagulation with low molecular weight heparin in COVID-19: cohort studies in Denmark and Sweden

Lars Christian Lund1, Pontus Hedberg2, Anne Helms Andreasen3

  • 1Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark; Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
|March 20, 2022
PubMed

Insights

Prophylactic low molecular weight heparin (LMWH) did not reduce mortality in hospitalized COVID-19 patients. This study found no significant benefit of LMWH on mortality or increased bleeding risk in these patients.

Area of Science:

  • Critical Care Medicine
  • Pharmacology & Pharmacy
  • Infectious Diseases

Background:

  • Hospitalized COVID-19 patients face risks of thrombotic events.
  • Prophylactic anticoagulation is a potential strategy to mitigate these risks.

Purpose of the Study:

  • To evaluate the safety and effectiveness of prophylactic low molecular weight heparin (LMWH) in hospitalized COVID-19 patients.
  • To assess the impact of early LMWH administration on mortality, ICU admission, bleeding, and venous thromboembolism.

Main Methods:

  • Observational cohort study using healthcare records from Denmark and Sweden (March 2020-September 2021).
  • Compared outcomes of COVID-19 patients receiving prophylactic LMWH within 48 hours of admission versus those who did not.
  • Used inverse probability weighting for confounder adjustment and random-effects meta-analysis for pooled risk ratios.

Main Results:

  • Pooled analysis included 3560 patients; 46-62% received prophylactic LMWH.
  • No significant reduction in mortality was observed (pooled risk ratio 0.91; 95% CI 0.60-1.38).
  • Relative risk of ICU admission was 1.12 (0.76-1.66), with no increased bleeding risk (0.63; 0.13-2.94) or venous thromboembolism (0.80; 0.43-1.47).

Conclusions:

  • Prophylactic LMWH showed no mortality benefit in hospitalized COVID-19 patients.
  • No increased risk of bleeding was associated with prophylactic LMWH use in this population.
  • Further research may be needed to define optimal anticoagulation strategies for COVID-19.
Abstract

Keywords:
COVID-19SARS-CoV-2anticoagulantspharmacoepidemiologyvenous thromboembolism

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