Prophylactic Anticoagulation with Low Molecular Weight Heparin in COVID-19: Cohort Studies in Denmark and Sweden

Saturday, August 27, 2022

1:45 PM – 2:00 PM CEST

Location: C1M1

Publication Number: 178

Background: Individuals hospitalised for coronavirus disease 2019 (COVID-19) are at an increased risk of venous thromboembolism (VTE). Based on limited evidence, current guidelines recommend that all individuals hospitalised for COVID-19 receive prophylactic anticoagulation.

Objectives: To evaluate safety and effectiveness of prophylactic anticoagulation with low molecular weight heparin (LMWH) in individuals hospitalised for COVID-19, compared to those not receiving anticoagulation.

Methods: Using healthcare records from the capital region of Denmark (March 2020-February 2021) and Karolinska University Hospital in Sweden (February 2020-September 2021), we conducted an observational cohort study among individuals hospitalised for COVID-19. We compared clinical outcomes 30 days after admission in individuals who received prophylactic LMWH during the first 48 hours of hospitalisation with outcomes among those not receiving prophylactic anticoagulation. We used inverse probability weighting to adjust for confounders and bias due to missing information. Risk ratios, risk differences and robust 95% confidence intervals (CI) were estimated using binomial regression. Country-specific risk ratios were pooled using a random-effects model and the DerSimonian-Laird estimator.

Results: We included 1692 and 1868 individuals in the Danish and Swedish cohorts. Of these, 771 (46%) and 1167 (63%) received prophylactic LMWH up to 48 hours after admission. The combined mortality in Denmark and Sweden was 12% (N=432) and the pooled risk ratio was 0.91 (CI 0.60-1.38) comparing individuals who received LMWH to those who did not. The relative risk of ICU admission was 1.12 (CI 0.76-1.66), while we observed no increased risk of bleeding (RR 0.63, 0.13-2.94). The relative risk of VTE was 0.80 (0.43-1.47).

Conclusions: We found no benefit on mortality with prophylactic LMWH and no increased risk of bleeding among COVID-19 patients receiving prophylactic LMWH.

Presenting Author(s)

Lars Christian Lund

Odense C, Syddanmark, Denmark

Slides

Co-Author(s)

PH

Pontus Hedberg

Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden, Sweden
AA

Anne Helms Andreasen

Center for Clinical Research and Prevention, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark, Denmark
JP

Janne Petersen

Copenhagen Phase IV unit, Department of Clinical Pharmacology and Center for Clinical research and Prevention, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark, Denmark
TP

Tonny Petersen

Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark, Denmark
Anton Pottegård, PhD, MSc

University of Southern Denmark
Odense C, Denmark
JB

Jacob Bodilsen

Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark, Denmark
PN

Pontus Naucler

Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden, Sweden
Jesper Hallas, MD, PhD, FISPE

University of Southern Denmark
Odense C, Syddanmark, Denmark
EJ

Espen Jimenez-Solem

Department of Clinical Pharmacology, Bispebjerg Hospital, Denmark