Therapeutic-dose anticoagulation and prophylactic-dose anticoagulation performed similarly in a 30-day composite outcome in patients hospitalized with COVID-19, a study shows. “However, fewer patients who were treated with therapeutic-dose anticoagulation required intubation or died,” the authors add.
Patients hospitalized with COVID-19 but not requiring intensive care unit (ICU) treatment were randomized to prophylactic-dose enoxaparin, therapeutic-dose enoxaparin, or therapeutic-dose apixaban. These results were identified based on a primary outcome of the 30-day composite of all-cause mortality, requirement for ICU level-of-care, systemic thromboembolism, or ischemic stroke: “Between August 26, 2020, and September 19, 2022, 3,398 non-critically ill patients hospitalized with COVID-19 were randomized to prophylactic-dose enoxaparin (n = 1141), therapeutic-dose enoxaparin (n = 1136) or therapeutic-dose apixaban (n = 1121) at 76 centers in 10 countries. The 30-day primary outcome occurred in 13.2% of patients in the prophylactic-dose group and 11.3% of patients in the combined therapeutic-dose groups (HR 0.85; 95% CI 0.69 to 1.04; P = 0.11). All-cause mortality occurred in 7.0% of patients treated with prophylactic-dose enoxaparin and 4.9% of patients treated with therapeutic-dose anticoagulation (HR 0.70; 95% CI 0.52 to 0.93; P = 0.01), and intubation was required in 8.4% vs. 6.4% of patients respectively (HR 0.75; 95% CI 0.58 to 0.98; P = 0.03). Results were similar in the two therapeutic-dose groups, and major bleeding in all three groups was infrequent.”