Comparison of standard prophylactic and preemptive therapeutic low molecular weight heparin treatments in hospitalized patients with COVID-19

Abstract

INTRODUCTION: Anticoagulant treatment approach in patients with COVID-19 is not well studied and not standardized. We aimed to compare the effects of standard prophylactic and pre-emptive therapeutic Low-Molecular-weight Heparin (LMWH) treatment approaches on mortality in patients with COVID-19. PATIENTS AND METHODS: This retrospective and single-centre study includes patients aged ≥ 18 years, who were diagnosed with COVID-19 and treated with LMWH during the hospital stay. Therapeutic dose of LMWH was defi ned as 1 mg/kg subcutaneously twice daily and prophylactic dose of LMWH was defi ned as 40 mg subcutaneously once daily. RESULTS: Among the 336 patients diagnosed with COVID-19 pneumonia, 115 patients, who received LMWH were included in the study. The mean age was 58.6 ± 13.3 and 58 (50.4 %) of the patients were male. Sixty-nine (60 %) of the patients were treated with prophylactic and 46 (40 %) therapeutic LMWH. In-hospital mortality was not different between patients treated therapeutic LMWH and prophylactic LMWH by the multivariate regression analysis (OR=2.187, 95% CI 0.484-9.880, p=0.309) and the propensity score modelling (OR=1.586, 95% CI 0.400-6.289, p=0.512.) CONCLUSION: Clinicians should consider the potential risks and benefi ts of standard prophylactic and pre-emptive therapeutic LMWH. Therefore, anticoagulant therapy should be individualized in patients with

Effects of low molecular weight heparin and fondaparinux on mortality, hemorrhagic and thrombotic complications in COVID-19 patients

“…After excluding duplicates and out-of-scope articles based on title/abstract, 349 potentially eligible records for inclusion were selected for full-text reading. After full-text reading, 318 articles were excluded, leading to the inclusion of 31 eligible studies 18–48 (6 RCTs and 25 cohort studies) with a total of 11,430 COVID-19 patients (Table 1). Only hospitalized patients were included in these studies.…”

High versus Standard Intensity of Thromboprophylaxis in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

“…Among the 8318 articles initially retrieved through our literature search, 21 fulfilled the inclusion criteria and were included in our analysis [ 11 , 12 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. The PRISMA 2020 flow diagram for systematic reviews and meta-analyses study selection is presented in Supplementary File, Figure S1 .…”

“…The PRISMA 2020 flow diagram for systematic reviews and meta-analyses study selection is presented in Supplementary File, Figure S1 . A total of 7 studies reported data for intermediate versus prophylactic dose [ 11 , 27 , 28 , 29 , 30 , 34 , 35 ], while 17 studies reported data for therapeutic versus prophylactic dose of thromboprophylaxis [ 12 , 23 , 24 , 25 , 26 , 29 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. Three studies contributed data for both intermediate versus prophylactic and therapeutic versus prophylactic dose analyses [ 29 , 34 , 35 ].…”

“…There were 2 randomized [ 12 , 33 ] and 15 observational studies [ 23 , 24 , 25 , 26 , 29 , 31 , 32 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ] ( n = 7776, weighted age 64 years, males 54%, ICU 21%) that reported the RR for death in patients with COVID-19 administered therapeutic versus prophylactic dose of thromboprophylaxis. Meta-analysis of these 17 studies (use of adjusted estimates for non-randomized) revealed a pooled adjusted RR for death at 0.73 (95% CI 0.47, 1.14; I 2 87%) ( Figure 2 ).…”

“…In sensitivity analyses, meta-analysis of 3 studies conducted exclusively in ICU [ 11 , 27 , 35 ] revealed a pooled adjusted RR for death in patients with COVID-19 administered intermediate versus prophylactic dose of thromboprophylaxis at 0.80 (95% CI 0.43, 1.50; I 2 59%), whereas meta-analysis of 4 studies conducted in general wards or mixed settings (general ward/ICU) [ 28 , 29 , 30 , 34 ] revealed a pooled adjusted RR at 0.47 (95% CI 0.29, 0.75; I 2 12%). Meta-analysis of 3 studies conducted exclusively in ICU [ 12 , 35 , 37 ] revealed a pooled adjusted RR for death in patients with COVID-19 administered therapeutic versus prophylactic dose of thromboprophylaxis at 0.58 (95% CI 0.35, 0.94; I 2 24%), whereas meta-analysis of 14 studies conducted in general wards or mixed settings (general ward/ICU) [ 23 , 24 , 25 , 26 , 29 , 31 , 32 , 33 , 34 , 36 , 38 , 39 , 40 , 41 ] revealed a pooled adjusted RR at 0.79 (95% CI 0.48, 1.30; I 2 89%).…”