Different doses of LMWH in hospitalized patients with COVID-19 – interim experience
Many experts recommend administering heparin to patients with COVID-19 as part of anticoagulant prophylaxis, especially in severe forms of this infection. However, data on dosage, administration duration, and the effectiveness of this approach are limited. Therefore, authors from Bologna, Italy, investigated the relationship between various doses of low-molecular-weight heparin (LMWH) and mortality in patients hospitalized with COVID-19.
Evaluated patient population and data
Data retrospectively obtained from 450 patients with laboratory-confirmed COVID-19 infection, admitted between March 1 and April 10, 2020, to the university hospital in Bologna were evaluated. Mortality during hospitalization with low-molecular-weight heparin prophylaxis was compared within the group.
A total of 361 patients received the standard prophylactic dose of LMWH (40–60 mg enoxaparin once daily), and 89 individuals received the so-called intermediate dose (40–60 mg enoxaparin twice daily). The low-molecular-weight heparin treatment lasted 7 days.
There were no significant demographic differences or differences in laboratory test results between the two groups of patients. Only in the group receiving the standard prophylactic dose, there was a higher representation of older patients and a higher prevalence of hypertension.
Results
A higher dose of LMWH in hospitalized patients was associated with lower all-cause mortality compared to the standard prophylactic dose (5.8% vs. 18.8%; p = 0.02). This difference remained significant even after adjusting for the so-called propensity score for the different variables in which the two groups differed (odds ratio [OR] 0.260; 95% confidence interval [CI] 0.089–0.758; p = 0.014).
Conclusion
The use of the so-called intermediate dose of LMWH in hospitalized patients with COVID-19 appears to be associated with a lower incidence of death compared to the administration of the standard LMWH dose. Further studies on anticoagulant treatment in these patients are ongoing, and their controlled design will be very important.
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Source: Paolisso P., Bergamaschi L., D'Angelo E. C. et al. Preliminary experience with low-molecular weight heparin strategy in COVID-19 patients. Front Pharmacol 2020 Aug 6; 11: 1124, doi: 10.3389/fphar.2020.01124.
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