Thromboprophylaxis with enoxaparin is associated with a lower death rate in patients hospitalized with SARS-CoV-2 infection. A cohort study
Background: 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. Thromboprophylaxis with enoxaparin is recommended by current guidelines, but evidence is st...
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Elsevier
2020-10-01
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Series: | EClinicalMedicine |
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Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537020303060 |
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doaj-ee09a7c36c1a48fc94c3117d8ed07263 |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Filippo Albani Lilia Sepe Federica Fusina Chiara Prezioso Manuela Baronio Federica Caminiti Antonella Di Maio Barbara Faggian Maria Elena Franceschetti Marco Massari Marcello Salvaggio Giuseppe Natalini |
spellingShingle |
Filippo Albani Lilia Sepe Federica Fusina Chiara Prezioso Manuela Baronio Federica Caminiti Antonella Di Maio Barbara Faggian Maria Elena Franceschetti Marco Massari Marcello Salvaggio Giuseppe Natalini Thromboprophylaxis with enoxaparin is associated with a lower death rate in patients hospitalized with SARS-CoV-2 infection. A cohort study EClinicalMedicine Coronavirus SARS-CoV-2 COVID-19 Heparin Low molecular weight heparin Thromboprophylaxis |
author_facet |
Filippo Albani Lilia Sepe Federica Fusina Chiara Prezioso Manuela Baronio Federica Caminiti Antonella Di Maio Barbara Faggian Maria Elena Franceschetti Marco Massari Marcello Salvaggio Giuseppe Natalini |
author_sort |
Filippo Albani |
title |
Thromboprophylaxis with enoxaparin is associated with a lower death rate in patients hospitalized with SARS-CoV-2 infection. A cohort study |
title_short |
Thromboprophylaxis with enoxaparin is associated with a lower death rate in patients hospitalized with SARS-CoV-2 infection. A cohort study |
title_full |
Thromboprophylaxis with enoxaparin is associated with a lower death rate in patients hospitalized with SARS-CoV-2 infection. A cohort study |
title_fullStr |
Thromboprophylaxis with enoxaparin is associated with a lower death rate in patients hospitalized with SARS-CoV-2 infection. A cohort study |
title_full_unstemmed |
Thromboprophylaxis with enoxaparin is associated with a lower death rate in patients hospitalized with SARS-CoV-2 infection. A cohort study |
title_sort |
thromboprophylaxis with enoxaparin is associated with a lower death rate in patients hospitalized with sars-cov-2 infection. a cohort study |
publisher |
Elsevier |
series |
EClinicalMedicine |
issn |
2589-5370 |
publishDate |
2020-10-01 |
description |
Background: 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. 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. Methods: Observational 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. Findings: At 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). 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. Moreover, when enoxaparin is used on the wards, it reduces the risk of Intensive Care Unit admission. |
topic |
Coronavirus SARS-CoV-2 COVID-19 Heparin Low molecular weight heparin Thromboprophylaxis |
url |
http://www.sciencedirect.com/science/article/pii/S2589537020303060 |
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doaj-ee09a7c36c1a48fc94c3117d8ed072632020-11-25T03:10:18ZengElsevierEClinicalMedicine2589-53702020-10-0127100562Thromboprophylaxis with enoxaparin is associated with a lower death rate in patients hospitalized with SARS-CoV-2 infection. A cohort studyFilippo Albani0Lilia Sepe1Federica Fusina2Chiara Prezioso3Manuela Baronio4Federica Caminiti5Antonella Di Maio6Barbara Faggian7Maria Elena Franceschetti8Marco Massari9Marcello Salvaggio10Giuseppe Natalini11Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, Italy; Corresponding author.Department of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, ItalyDepartment of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, ItalyDepartment of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, Italy; Department of Intensive Care Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, ItalyDepartment of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, ItalyDepartment of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, ItalyDepartment of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, ItalyDepartment of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, ItalyDepartment of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, ItalyDepartment of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, ItalyDepartment of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, ItalyDepartment of Anesthesia and Intensive Care, Fondazione Poliambulanza Hospital, via Bissolati, 57, Brescia 25124, ItalyBackground: 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. 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. Methods: Observational 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. Findings: At 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). 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. Moreover, when enoxaparin is used on the wards, it reduces the risk of Intensive Care Unit admission.http://www.sciencedirect.com/science/article/pii/S2589537020303060CoronavirusSARS-CoV-2COVID-19HeparinLow molecular weight heparinThromboprophylaxis |