Among patients admitted to hospital with COVID-19, early use of prophylactic anticoagulation appears to lower the risk of 30-day mortality, according to research published in the BMJ.

A proportion of deaths among patients infected with SARS-CoV-2, the virus that causes COVID-19, have been caused, at least in part, by venous thromboembolism and arterial thrombosis. Nearly one-third of patients with COVID-19 in intensive care have developed venous thromboembolism, suggesting that prevention of this complication may help to lower the death burden associated with this disease.

Several healthcare organizations have, in light of these findings, recommended that, where not contraindicated, patients admitted to intensive care with COVID-19 receive prophylactic anticoagulation to lower the risk of thromboembolism. There has not, however, been any previous study evaluating the effectiveness of prophylactic anticoagulation for reducing mortality risk in this population. For this study, researchers evaluated whether this intervention reduces the risk of 30-day mortality among patients with COVID-19 admitted to a US Department of Veterans Affairs hospital.

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Overall, data from 4297 patients admitted to hospital were included, among whom 670 received no anticoagulation and 3627 received prophylactic anticoagulation. In the no-anticoagulation and anticoagulation groups, the median ages were 69 and 68.1 years, respectively; 92.5% and 93.6% of patients were male; and 72.1% and 76.9% of patients were former or current smokers. Nearly all patients in the anticoagulant group received subcutaneous heparin or enoxaparin.

In the overall population, 622 deaths were noted, 513 of which were among those in the anticoagulation group. After weighting analyses by inverse probability of treatment, the cumulative 30-day mortality incidence was 14.3% in the anticoagulation group vs 18.7% in the no-anticoagulation group – corresponding to a 27% reduction in 30-day mortality risk with anticoagulation (hazard ratio [HR], .73)

Anticoagulation was not, furthermore, linked with an increased risk of bleeding leading to transfusion (HR, .87).

“Our results 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,” the authors wrote.

Disclosures: Some authors have declared affiliations with or received funding from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.


Rentsch CT, Beckman JA, Tomlinson L, et al. Early initiation of prophylactic anticoagulation for prevention of coronavirus disease 2019 mortality in patients admitted to hospital in the United States: cohort study. BMJ. Published online February 11, 2021. doi:10.1136/bmj.n311