ABSTRACT
A hypercoagulability state with fatal thrombosis events seems to characterize the clinical worsening of COVID-19 pneumonia. The benefit and safety of anticoagulant doses of low molecular weight heparin (LMWH) in COVID-19 are still unknown. We evaluated in a retrospective cohort study 257 COVID-19 patients consecutively admitted to our COVID-Hospital from February 29, to April 7, 2020. We compared the in-hospital mortality between patients treated with prophylactic or therapeutic doses of LMWH. Of the 257 patients enrolled, 49 (19.1%) died during the hospitalization. Hospital mortality was significantly lower in patients treated with therapeutic doses of LMWH (enoxaparin 70-100 I.U./kg twice daily) (17/126, 13.5%), than in patients treated with prophylactic doses (60-90 I.U./kg once daily) (32/131, 24.4%; χ²=4.98, p = 0.02). In a stratified analysis by ventilation type, the only subgroup of patients who benefited from therapeutic LMWH was that requiring noninvasive mechanical ventilation (OR=0.099, 95% CI 0.028-0.354, p<0.001). No fatal bleedings were observed. In this retrospective study the treatment with therapeutic LMWH is safe and seems to reduce mortality in COVID-19 patients, especially among those who need noninvasive mechanical ventilation. Authors Daniela Aschieri and Marco Stabile contributed equally to this work.