(HealthDay News) — For adult inpatients with COVID-19 who have elevated D-dimer levels, therapeutic-dose low-molecular-weight heparin (LMWH) reduces major thromboembolism and death compared with standard heparin thromboprophylaxis, according to a study published online Oct. 7 in JAMA Internal Medicine.

Alex C. Spyropoulos, M.D., from the Feinstein Institutes for Medical Research in Manhasset, N.Y., and colleagues examined the effects of therapeutic-dose LMWH versus institutional standard prophylactic or intermediate-dose heparins for thromboprophylaxis in high-risk hospitalized adults with COVID-19 who had evidence of coagulopathy (D-dimer level more than four times the upper limit of normal or sepsis-induced coagulopathy score of 4 or greater). A total of 257 patients were randomly assigned, and 253 were included in the analysis. Overall, 124 and 129 patients were included in the standard-dose heparins and therapeutic-dose LMWH groups, respectively.

The researchers found that the primary efficacy outcome of venous thromboembolism, arterial thromboembolism, or death from any cause was met by 41.9 and 28.7 percent of patients receiving standard-dose heparins and therapeutic-dose LMWH (relative risk, 0.68), including a reduction in thromboembolism (29.0 percent versus 10.9 percent; relative risk, 0.37), respectively. The incidence of major bleeding did not differ significantly and was 1.6 and 4.7 percent with standard-dose and therapeutic-dose heparins, respectively. The primary efficacy outcome was significantly reduced in non-intensive care unit (ICU) patients, but it was not reduced in ICU patients.


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“Randomized clinical trials in this patient population to assess any further benefits of therapeutic anticoagulation are ongoing, and novel antithrombotic strategies in critically ill patients with COVID-19 are needed,” the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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