Prevention of Thromboembolic Events in Patients with COVID-19

Abstract

Background: COVID-19 has developed into a global pandemic with respiratory compromise and systemic coagulopathy causing significant morbidity and mortality. Methods: A retrospective analysis was performed on all COVID-19 patients hospitalized between March and June 2020. Findings: Of 1265 COVID-19 positive hospitalized patients identified, 138 (10.9%) had a thromboembolism. Mortality rate in COVID-19 patients with thrombosis was 31.9%, significantly higher than COVID-19 patients who did not have thrombosis 10% (p<0.0001). The incidence of thrombosis was significantly less in those who received steroids at 14% as compared to other COVID-19 therapies: tocilizumab 25% (p=0.0031), hydroxychloroquine 42% (p<0.0001), and remdesivir 72% (p<0.0001). There was no difference in mortality in patients who had prophylactic enoxaparin 40.5% than therapeutic enoxaparin 51.7% (p= 0.3491). Adjusting for demographics, a logistics model showed no mortality difference in patients who had either dosing of anticoagulation (p=0.5810). The bleeding rate was 12.3%, significantly higher than reported bleeding rates for hospitalized nonCOVID-19 patients on anticoagulants at 7.2% (p<0.05). Interpretation: Our study shows the incidence of thrombosis in hospitalized COVID-19 patients was higher than the general population. The lowest incidence of thrombosis occurred in COVID-19 patients who received steroids. There was no mortality difference in patients who received prophylactic versus therapeutic anticoagulation prior to thrombosis, but there was a high incidence of bleeding events. Funding: No outside funding was used