Thromboprophylaxis with enoxaparin is associated with a lower death rate in patients hospitalized with SARS-CoV-2 infection. A cohort study.

Filippo Albani,Marco Massari,Antonella Di Maio,Lilia Sepe,Barbara Faggian,Chiara Prezioso,Maria Elena Franceschetti,Federica Fusina,Marcello Salvaggio,Giuseppe Natalini,Federica Caminiti,Manuela Baronio

doi:10.1016/j.eclinm.2020.100562

Abstract

BackgroundSevere Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) infection is associated with hypercoagulability caused by direct invasion of endothelial cells and\\or proinflammatory cytokine release. Thromboprophylaxis with enoxaparin is recommended by current guidelines, but evidence is still weak. The aim of this study was to assess the impact of thromboprophylaxis with enoxaparin on hospital mortality in patients admitted for Coronavirus disease 2019 (COVID-19). The effects of enoxaparin on intensive care admission and hospital length-of-stay were evaluated as secondary outcomes.MethodsObservational cohort study, with data collected from patients admitted to Poliambulanza Foundation with positive real time reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 from 20th February to 10th May 2020. Multivariate logistic regression with overlap weight propensity score was used to model hospital mortality and intensive care admission, hospital length-of-stay was analyzed with a multivariate Poisson regression. Seven hundred and ninety nine (57%) patients who received enoxaparin at least once during the hospitalization were included in the enoxaparin cohort, 604 (43%) patients who did not were included in the control cohort.FindingsAt the adjusted analysis enoxaparin was associated with lower in-hospital mortality (Odds Ratio 0·53, 95% C.I. 0·40–0·70) compared with no enoxaparin treatment. Hospital length-of-stay was longer for patients treated with enoxaparin (Incidence Rate Ratios 1·45, 95% C.I. 1·36–1·54). Enoxaparin treatment was associated with reduced risk of intensive care admission at the adjusted analysis (Odds Ratio 0·48, 95% C.I. 0·32–0·69).InterpretationThis study shows that treatment with enoxaparin during hospital stay is associated with a lower death rate and, while results from randomized clinical trials are still pending, this study supports the use of thromboprophylaxis with enoxaparin in all patients admitted for COVID-19. Moreover, when enoxaparin is used on the wards, it reduces the risk of Intensive Care Unit admission.

Highlights

Coronavirus disease 2019 (COVID-19) is a new disease, caused by Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) infection.Manifestations of hypercoagulability are common, associated with acute inflammatory changes and laboratory alterations [1,2]
The aim of this study was to assess the impact of thromboprophylaxis with enoxaparin on hospital mortality in patients admitted for COVID-19
Patients were included in the study if they were admitted to the hospital and if real time reverse transcription polymerase chain reaction from a nasopharyngeal swab or bronchoalveolar lavage resulted positive for SARS-CoV-2

Summary

Introduction

Coronavirus disease 2019 (COVID-19) is a new disease, caused by Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) infection.Manifestations of hypercoagulability are common, associated with acute inflammatory changes and laboratory alterations [1,2]. Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) infection is associated with hypercoagulability caused by direct invasion of endothelial cells and\or proinflammatory cytokine release. The aim of this study was to assess the impact of thromboprophylaxis with enoxaparin on hospital mortality in patients admitted for Coronavirus disease 2019 (COVID-19). Findings: At the adjusted analysis enoxaparin was associated with lower in-hospital mortality (Odds Ratio 0¢53, 95% C.I. 0¢40À0¢70) compared with no enoxaparin treatment. Enoxaparin treatment was associated with reduced risk of intensive care admission at the adjusted analysis (Odds Ratio 0¢48, 95% C.I. 0¢32À0¢69). Interpretation: This study shows that treatment with enoxaparin during hospital stay is associated with a lower death rate and, while results from randomized clinical trials are still pending, this study supports the use of thromboprophylaxis with enoxaparin in all patients admitted for COVID-19. When enoxaparin is used on the wards, it reduces the risk of Intensive Care Unit admission

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