1 Department of Research and Public Health, Reims University Hospital, 51092 Reims, France.
2 UR 3797 Vieillissement, Fragilité (VieFra), faculty of medicine, University of Reims Champagne-Ardenne, 51092 Reims, France.
3 Department of Hematology Laboratory, Reims University Hospital, 51092 Reims, France.
4 Department of Internal Medicine, Clinical Immunology and Infectious Diseases, Reims University Hospital, 51092 Reims, France.
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Background: Severe forms of SARS-CoV-2 infections are associated with high rates of thromboembolic complications. Professional societies and expert consensus reports have recommended anticoagulants for COVID-19 hospitalized patients. Our study aimed to compare the effect of therapeutic, intermediate and prophylactic doses of heparin on 6-week survival in patients hospitalized for COVID-19.
Methods. The study sample is a French cohort of COVID-19 patients hospitalized between Feb 25th and Apr 30th 2020. Patients were assigned to one of 3 anticoagulation dose groups based on the maximum dose they received for at least three days (prophylactic, intermediate or therapeutic). The main outcome was survival up to 42 days after hospital admission. Multivariate Cox regression models were performed to adjust analyses for confounding factors.
Results. A total of 323 patients were included. The mean age of the study sample was 71.6 ± 15 years, and 56.3% were men. Treatment with the intermediate versus prophylactic dose of anticoagulation (HR = 0.50, 95%CI = [0.26; 0.99], p = 0.047) and with therapeutic versus prophylactic dose (HR = 0.58 95%CI = [0.34; 0.98], p = 0.044) was associated with a significant reduction in 6-week mortality, after adjustment for potential confounding factors. Comparison of therapeutic versus intermediate doses showed no significant difference in survival.
Conclusions. Our results reported a significant positive effect of intermediate and therapeutic doses of heparin on 6-week survival for hospitalized COVID-19 patients compared with a prophylactic dose.
|Figure 1. Flow chart of the study population. Abbreviations: P, prophylactic; I, intermediate; T, therapeutic.|
|Table 1. Characteristics of the study population according to the dose of anticoagulant received (prophylactic, intermediate or therapeutic) during hospitalization for COVID-19.|
|Table 2. Schemes of anticoagulant doses received by each patient.|
|Figure 2. Comparison of Kaplan-Meier survival curves with 95% confidence intervals.|
|Table S1. Examples of anticoagulant doses|
|Table S2. Bivariate analysis of the effects of patient characteristics on 6-week survival.|