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Report of Low Incidence of Thrombosis with Early Prophylaxis in Hospitalized Patients with COVID-19 from Two Saudi
Tarek Owaidah1,2, Khalid Maghrabi3, Feras Alfraih4
1Department of Pathology and Laboratory Medicine, 37852King Faisal Specialist Hospital and Research Centre, Riyadh, KSA.
Insights
Early prophylactic anticoagulants in hospitalized COVID-19 patients showed a low thrombosis incidence (1.9%) and reduced mortality. Higher VTE scores correlated with ICU admission and death, underscoring the benefit of early anticoagulation.
Area of Science:
- Cardiology
- Infectious Diseases
- Hematology
Background:
- Thrombotic events significantly increase mortality in COVID-19 patients.
- Prophylactic anticoagulants have demonstrated efficacy in reducing thrombosis, mortality, and ICU admissions among COVID-19 patients.
Purpose of the Study:
- To investigate the incidence of thrombosis with early anticoagulation prophylaxis in hospitalized COVID-19 patients.
- To identify risk factors associated with thrombotic events.
- To evaluate the overall survival rate in this cohort.
Main Methods:
- Prospective observational study of 425 hospitalized COVID-19 patients (≥14 years) in Saudi Arabia.
- Evaluation of Venous Thromboembolism (VTE) scores and administration of VTE prophylaxis per hospital guidelines.
- Recording of demographics, comorbidities, disease presentation, and sequential hematological profiles.
Main Results:
- A low incidence of thrombosis (1.9%) was observed, with pulmonary embolism as the most common type.
- VTE prophylaxis was given to 92.7% of patients, primarily enoxaparin (86.3%).
- A significant association was found between high VTE scores, ICU admission (28%), and mortality (5.9%), particularly in ICU patients (16% mortality).
Conclusions:
- Early administration of prophylactic anticoagulants is associated with a low incidence of thrombosis and reduced mortality in COVID-19 patients.
- Higher VTE scores are linked to increased risk of ICU admission and mortality.
- This study supports the use of early anticoagulation prophylaxis in hospitalized COVID-19 patients.
Background:
Thrombotic events can increase the COVID-19 associated disease mortality. The administration of prophylactic anticoagulants had been shown to decrease the incidence of thrombosis, mortality, and ICU admission rates in COVID-19 patients.
Aims:
The present study investigates the rate of thrombosis with early anticoagulation prophylaxis, the various risk factors for thrombotic events, and the overall survival rate in hospitalized COVID-19 cases.
Methods:
In this prospective observational study, 425 patients aged ≥14 years were included in the study who were hospitalized with COVID-19 related symptoms from March to October 2020 at two tertiary care hospitals in the Kingdom of Saudi Arabia. Venous thromboembolism (VTE) score was evaluated, and VTE prophylaxis was administered according to the hospital guidelines. Patients' demographics, comorbidities, disease presentation, and sequential hematological profiles were also recorded. Samples were collected at different time points to determine the hematological profiles.
Results:
Out of 425 with positive COVID-19 subjects, eight (1.9%) patients developed thrombosis during admission, with pulmonary embolism being the most common type. VTE prophylaxis was administered to 394 (92.7%) patients. These anticoagulants included enoxaparin (86.3%), heparin (12.7%), warfarin (0.8%) and apixaban (0.3%). Comorbid conditions were recorded in 253 (59.5%) patients. ICU admission rate was 28% (n = 119), with a median time to transfer to ICU of 1 day (r: 0-33 days). A trend of high VTE score (5.0) with ICU admission and mortality (P = <.001) was observed. The observed mortality rate for our cohort was 5.9% (25 events out of 425); however, for patients admitted in ICU, it was 16% (19 events out of 119 admissions).
Conclusion:
We are reporting a low incidence of thrombosis in COVID-19 patients. We have demonstrated that the early administration of prophylactic anticoagulants might reduce the risk of thrombotic events and the associated mortality. We observed a higher VTE score and thrombosis in patients admitted to the ICU.
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