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.
【저자키워드】 COVID-19, Mortality, Thromboprophylaxis, Enoxaparin doses, 【초록키워드】 Treatment, ARDS, mechanical ventilation, intubation, Prophylactic, Venous Thromboembolism, hospitals, Randomized, adverse event, Patient, death, incidence, association, acute respiratory distress, Anticoagulant, dose, regimen, low molecular weight, prophylactic dose, In-hospital death, In-hospital, supplementary material, higher risk, 95% CI, overall mortality, dosage, all-cause mortality, syndrome, multivariable analysis, outcome measure, doses, primary end-point, significantly lower, LMWH, Italian, secondary, thrombotic event, evaluated, treated, appear, suggested, consecutive patient, patients hospitalized, patients with COVID-19, pro-thrombotic, 【제목키워드】 outcome, clinical, different dose, patients hospitalized,