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Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
Published on: October 12, 2012
Comparing Therapeutic versus Prophylactic Enoxaparin Therapy in Severe COVID-19 Patients: A Randomized Clinical Trial
Samira Kafan1, Mohammad Reza Fattahi1,2,3, Mahsa Akhbari Shojaei1
1Department of Internal Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Prophylactic enoxaparin significantly improved survival and reduced adverse events in severe COVID-19 patients compared to therapeutic doses. This suggests a potential benefit of prophylactic anticoagulation for critically ill patients with COVID-19.
Area of Science:
- Critical Care Medicine
- Hematology
- Infectious Diseases
Background:
- COVID-19 is linked to hypercoagulopathy, increasing thrombotic event risk.
- The optimal anticoagulant strategy for severe COVID-19 remains unclear.
- Enoxaparin is a common anticoagulant used in hospitalized patients.
Purpose of the Study:
- To compare the efficacy of prophylactic versus therapeutic enoxaparin doses.
- To evaluate the impact on survival and adverse events in severe COVID-19.
- To identify the optimal anticoagulation strategy for severe COVID-19 patients.
Main Methods:
- Single-center, open-label, randomized controlled trial.
- 237 severe COVID-19 patients with elevated D-dimer were randomized.
- Primary outcome: overall survival; Secondary outcomes: ICU admission, mechanical ventilation, major adverse events (MAEs).
Main Results:
- Prophylactic enoxaparin showed significantly better survival (22.3% vs 44.8%, P < 0.001).
- Lower rates of ICU admission (P < 0.001) and MAEs (P = 0.009) in the prophylactic group.
- Shorter hospitalization duration observed with prophylactic enoxaparin (P = 0.028).
Conclusions:
- Prophylactic enoxaparin demonstrated superior outcomes in severe COVID-19 patients.
- Findings suggest prophylactic anticoagulation may be beneficial.
- Further research is warranted due to study limitations.
Background:
Coronavirus disease 2019 (COVID-19) has been associated with a hypercoagulopathy state; however, the efficacy of different anticoagulant regimens in preventing thrombotic events is not clear. We aimed to compare therapeutic versus prophylactic enoxaparin therapy in severe COVID-19 patients.
Methods:
In this single-center, open-label, randomized controlled trial, adult patients with severe COVID-19 presentations and an increased D-dimer level of more than 4 times the normal upper limit were randomly assigned to receive either prophylactic or therapeutic dose of enoxaparin. All patients were observed for at least 4 months regarding the overall survival as the primary outcome. Hospitalization duration, the need for intensive care unit (ICU) admission, the need for mechanical ventilation, and major adverse events (MAEs) were also analyzed as the secondary outcomes. Survival analysis was done via Kaplan-Meier curves and the Log-rank test. Cox regression was used, adjusting for baseline variables.
Results:
Overall, 237 patients (152 men and 85 women) were randomized to either arm (121 to prophylactic and 116 to therapeutic groups). The mortality rate was 27 (22.3%) and 52 (44.8%) in prophylactic and therapeutic arms, respectively. Prophylactic enoxaparin was associated with better survival in the log-rank test (P < 0.001; HR, 0.42). Additionally, a significantly lower rate of ICU admission, a lower rate of MAEs, and shorter hospitalization were observed in the prophylactic arm (P < 0.001, P = 0.009, and P = 0.028, respectively).
Conclusion:
The results of the current study were in favor of anticoagulant treatment with prophylactic doses of enoxaparin. Still, due to the limitations of this paper, we suggest that these findings be treated cautiously.
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