Anticoagulants in COVID-19:Is there a role for a D-dimerdriven dosing ?

ABSTRACT

Introduction: The optimal anticoagulant treatment regimen in hospitalized COVID-19 patients is debated amid studies investigating the effectiveness of different dosing strategies. Aims and Objectives: The aim of this study was to compare the rates of disease progression and mortality in patients treated with LMWH according to a protocol based on baseline D-dimer levels (prophylactic dose when level is below 1000 ng/mL, intermediate dose between 1000 and 3000 ng/mL, therapeutic dose when levels exceed 3000 ng/mL)(on-protocol) and those treated with a fixed-dose regimen (off-protocol). Method(s) This was a retrospective analysis of all patients admitted to a university hospital for COVID-19 pneumonia during a one-year period. Out of a total of 384 patients (mean age 61.5+/-15.9y, 216 male), 294 patients with complete data composed the study group. Result(s) 174 patients were treated on-protocol and 120 patients were off-protocol. The on-protocol group had higher CRP, ferritin, LDH and D-dimer levels and lower SpO2/FiO2 levels at admission. Disease progression developed in 44 out of 174 on-protocol patients (25.3%) vs 53 of 120 off-protocol patients (44.2%) during the follow-up (p=0.001) and 29 (16.7%) vs 32 (26.7%), respectively, died in hospital (p=0.041). Logistic regression analysis was performed and included age, presence of comorbidities, LMWH regimen, baseline SpO2/FiO2, CRP and LDH levels as independent variables. The presence of cardiac comorbidity, age and LDH levels, but not LMWH treatment regimen, were associated with both disease progression and mortality. Conclusion(s) A d-dimer-driven LMWH treatment protocol is not associated with better clinical outcomes in hospitalized COVID-19 patients.