Clinical outcome with different doses of low-molecular-weight heparin in patients hospitalized for COVID-19

Mennuni, Marco G.; Renda, Giulia; Grisafi, Leonardo; Rognoni, Andrea; Colombo, Crizia; Lio, Veronica; Foglietta, Melissa; Petrilli, Ivan; Pirisi, Mario; Spinoni, Enrico; Azzolina, Danila; Hayden, Eyal; Aimaretti, Gianluca; Avanzi, Gian Carlo; Bellan, Mattia; Cantaluppi, Vincenzo; Capponi, Andrea; Castello, Luigi M.; D’Ardes, Damiano; Corte, Francesco Della; Gallina, Sabina; Krengli, Marco; Malerba, Mario; Pierdomenico, Sante D.; Savoia, Paola; Zeppegno, Patrizia; Sainaghi, Pier P.; Cipollone, Francesco; Patti, Giuseppe

A 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11239-021-02401-x.