Early initiation of prophylactic anticoagulation for prevention of coronavirus disease 2019 mortality in patients admitted to hospital in the United States: cohort study
Study of patients admitted to hospital with Covid-19 (n=4297) found receipt of thromboprophylaxis within 24 hours of admission was associated with lower 30-day mortality (14.3% v 18.7% no anticoagulation; HR 0.73, 95% CI 0.66 to 0.81) with no increased risk of severe bleeding.
Source:
British Medical Journal
SPS commentary:
The most common anticoagulants used were subcutaneous heparin (n=1094, 30.2%) and enoxaparin (n=2506, 69.1%). Post-hoc analyses showed bleeding events that required transfusion were relatively rare (n=198, 4.6%), and that use of prophylactic anticoagulation was not associated with an increased risk of such events (HR 0.87, 95% CI 0.71 to 1.05). No other safety data is presented.
The authors say their findings provide “strong real-world evidence to support guidelines recommending the use of prophylactic anticoagulation as initial treatment for patients with covid-19 on hospital admission.”
NICE published a rapid guideline on reducing the risk of venous thromboembolism in over 16s with COVID-19 in November 2020. For hospitalised patients with Covid-19 pneumonia, this recommends pharmacological VTE prophylaxis be offered unless contraindicated, with a standard prophylactic dose (for acutely ill medical patients) of low molecular weight heparin.