In a study of non-critically ill patients hospitalized with COVID-19, therapeutic-dose anticoagulation and prophylactic-dose anticoagulation produced statistically similar 30-day primary composite outcomes. However, fewer patients treated with therapeutic-dose anticoagulation required intubation or died, the investigators note.
Between Aug. 26, 2020, and Sept. 19, 2022, at 76 centers in 10 countries, 3,398 patients with COVID-19 and not requiring ICU treatment were randomized to prophylactic-dose enoxaparin, therapeutic-dose enoxaparin, or therapeutic-dose apixaban. Based on a 30-day composite of all-cause mortality, requirement for ICU level-of-care, systemic thromboembolism, or ischemic stroke, the study showed: “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.”