Clinical Outcomes With the Use of Prophylactic Versus Therapeutic Anticoagulation in COVID-19

ABSTRACT

BackgroundThis study is the first of its kind to assess the impact of preemptive therapeutic dose anticoagulation on mortality compared to prophylactic anticoagulation among COVID-19 patients. Its findings provide insight to clinicians regarding the management of COVID-19, particularly with the known prothrombotic state. Research QuestionTo determine the impact of anticoagulation on in-hospital mortality among COVID-19 positive patients with the a priori hypothesis that there would be a lower risk of in-hospital mortality with use of preemptive therapeutic over prophylactic dose enoxaparin or heparin. Study Design and MethodsO_ST_ABSStudy DesignC_ST_ABSRetrospective cohort study from April 1 - April 25, 2020. The date of final follow-up was June 12, 2020. SettingTwo large, acute care hospitals in Western Connecticut. ParticipantFive hundred and one inpatients were identified after discharge as 18 years or older and positive for SARS-CoV-2. The final sample size included 374 patients after applying exclusion criteria. Demographic variables were collected via hospital billing inquiries, while the clinical variables were abstracted from patients medical records. ExposurePreemptive enoxaparin or heparin at a therapeutic or prophylactic dose. Main OutcomIn-hospital mortality. ResultsWhen comparing preemptive therapeutic to prophylactic anticoagulation through multi-variable analysis, risk of in-hospital mortality was 2.3 times greater in patients receiving preemptive therapeutic anticoagulation (95% CI = 1.0, 4.9; p = 0.04). InterpretationAn increase in in-hospital mortality was observed with preemptive therapeutic anticoagulation. Thus, in the management of COVID-19 and its complications, we recommend further research and cautious use of preemptive therapeutic over prophylactic anticoagulation.