In this episode, I’ll discuss an article that compares mortality in COVID-19 patients who received enoxaparin vs those who received unfractionated heparin.
Managing coagulopathies in patients hospitalized with COVID-19 is one of the more challenging aspects of care for these patients.
While prospective trials are ongoing, a retrospective analysis has the benefit of quickly providing some evidence to guide treatment decisions until longer trials are completed.
Researchers recently published in Lancet a retrospective analysis of over 1000 patients in the Mayo Clinic database looking at mortality in patients with COVID-19 who received enoxaparin or unfractionated heparin (UFH).
The study included both patients who received prophylactic anticoagulant doses and those who received treatment doses.
While the primary analysis looked at differences in mortality by anticoagulant type, secondary endpoints stratified based on prophylactic vs therapeutic dosing strategy.
Propensity score matching was used in order to attempt to control for potential confounding factors.
The study only analyzed patients who received exclusively one anticoagulant (enoxaparin or UFH) within 28 days after hospitalization.
There were 441 patients in the enoxaparin group and 166 in the heparin group.
Patients who were only administered UFH had a higher 28 day mortality with a risk ratio of 4.3.
In the secondary analysis by dosing type the authors found:
Among the patients who have exclusively taken prophylactic doses with 28-day mortality outcomes available, we observe that unfractionated Heparin patients have a similar mortality rates compared to Enoxaparin patients (unfractionated Heparin: 5/39 [13%] vs. Enoxaparin: 6/49 [12%]). Among the patients who have taken either therapeutic doses or both therapeutic/prophylactic doses with 28-day mortality outcomes available, we observe that unfractionated Heparin patients have a much higher mortality rates compared to Enoxaparin patients (unfractionated Heparin: 5/22 [23%] vs. Enoxaparin: 0/6 [0%]).
In the safety analysis, patients administered Enoxaparin had fewer bleeding events during the 28-day study period compared to patients administered UFH.
The SCCM COVID-19 guidelines had already expressed a preference for enoxaparin over UFH due to lower bleeding risks in non-COVID-19 patients. This study confirms that finding with retrospective data, and suggests a mortality benefit with enoxaparin as well.
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