• Marco G Mennuni, Giulia Renda, Leonardo Grisafi, Andrea Rognoni, Crizia Colombo, Veronica Lio, Melissa Foglietta, Ivan Petrilli, Mario Pirisi, Enrico Spinoni, Danila Azzolina, Eyal Hayden, Gianluca Aimaretti, Gian Carlo Avanzi, Mattia Bellan, Vincenzo Cantaluppi, Andrea Capponi, Luigi M Castello, Damiano D'Ardes, Francesco Della Corte, Sabina Gallina, Marco Krengli, Mario Malerba, Sante D Pierdomenico, Paola Savoia, Patrizia Zeppegno, Pier P Sainaghi, Francesco Cipollone, Giuseppe Patti, and COVID-UPO Clinical Team.
• Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.
• J. Thromb. Thrombolysis. 2021 Oct 1; 52 (3): 782-790.

AbstractA pro-thrombotic milieu and a higher risk of thrombotic events were observed in patients with CoronaVirus disease-19 (COVID-19). Accordingly, recent data suggested a beneficial role of low molecular weight heparin (LMWH), but the optimal dosage of this treatment is unknown. We evaluated the association between prophylactic vs. intermediate-to-fully anticoagulant doses of enoxaparin and in-hospital adverse events in patients with COVID-19. We retrospectively included 436 consecutive patients admitted in three Italian hospitals. Outcome according to the use of prophylactic (4000 IU) vs. higher (> 4000 IU) daily dosage of enoxaparin was evaluated. The primary end-point was in-hospital death. Secondary outcome measures were in-hospital cardiovascular death, venous thromboembolism, new-onset acute respiratory distress syndrome (ARDS) and mechanical ventilation. A total of 287 patients (65.8%) were treated with the prophylactic enoxaparin regimen and 149 (34.2%) with a higher dosing regimen. The use of prophylactic enoxaparin dose was associated with a similar incidence of all-cause mortality (25.4% vs. 26.9% with the higher dose; OR at multivariable analysis, including the propensity score: 0.847, 95% CI 0.400-0.1.792; p = 0.664). In the prophylactic dose group, a significantly lower incidence of cardiovascular death (OR 0.165), venous thromboembolism (OR 0.067), new-onset ARDS (OR 0.454) and mechanical intubation (OR 0.150) was observed. In patients hospitalized for COVID-19, the use of a prophylactic dosage of enoxaparin appears to be associated with similar in-hospital overall mortality compared to higher doses. These findings require confirmation in a randomized, controlled study.© 2021. The Author(s).

35 keywords...

hide…