Evaluating the Effectiveness of NOACs and LMWH in Reducing Mortality in Critically Ill Patients With COVID-19

Severe COVID-19 is associated with increased prothrombotic and inflammatory responses, necessitating effective anticoagulation therapy. Novel oral anticoagulants (NOACs) are being explored as potential alternatives to low-molecular-weight heparin (LMWH). This retrospective observational cohort study compared the effectiveness and safety of NOACs and LMWH in reducing mortality among 76 critically ill, unvaccinated patients with confirmed SARS-CoV-2 infection. The cohort included 41 patients treated with LMWH and 35 with NOACs during their ICU stay. The primary outcomes was mortality, while secondary outcomes included deep vein thrombosis (DVT), bleeding episodes, and transfusion rates. Baseline characteristics, including demographic data and severity scores, were similar between the groups (mean age: LMWH, 74.5 ± 15.1 years [59% male]; NOAC, 71.6 ± 14.8 years [60% male]). Mortality was significantly higher in the LMWH group (51.21% [95% confidence interval (CI): 36.4-65.7]) compared to the NOAC group (20% [95% CI: 10.0-35.9]; p = 0.005), with standardized mortality ratios of 1.61 and 0.71, respectively (p = 0.004). Elevated d-dimer levels were strongly associated with an increased risk of mortality. Deep vein thrombosis (DVT) occurred in 9.76% of patients in the LMWH group and 5.71% of those in the NOAC group (p = 0.68). Bleeding and transfusion rates were comparable between the groups. The use of NOACs was associated with a significantly lower mortality rate compared to LMWH in critically ill COVID-19 patients, reflecting an 81% reduction in the risk of death. These findings highlight the potential benefits of NOACs in the management of severe COVID-19 and underscore the need for further research to optimize anticoagulation strategies and improve patient outcomes.