PB0061 - Standard dosing of Enoxaparin Versus unfractionated heparin in critically ill COVID19 patients: A Multicenter Cohort Study

Background: Venous thromboembolism remains a major complication associated with a high incidence of mortality in COVID-19 patients. Prophylactic anticoagulation utilizing either unfractionated heparin (UFH) or low molecular weight heparin (LMWH) remains an area of further investigation.

Aims: To evaluate the incidence of thrombotic, clinical outcomes of interest and safety of LMWH versus UFH in critically ill COVID-19.

Methods: This is a multicenter, retrospective cohort study including adult critically ill patients with confirmed COVID-19 and admitted to the ICU. Included patients were grouped based on the anticoagulation agent. The primary outcome was conformed arterial or venous thrombosis. Secondary outcomes included bleeding (major or minor), 30-day mortality, hospital length of stay (LOS), ICU LOS, ventilator-free days (VFDs) at 30 days, and ICU-acquired complications.We adjusted comparisons for potential confounders using regression analysis. A P-value < 0.05 will indicate statistical significance and all analyses will be performed using STATA version 9.4.

Results: 305 patients were included, 142 received UFH and 164 received LMWH. A statistical significant decrease in hospital LOS with the use of LMWH compared to UFH was observed (hazard ratio [HR] -0.28, p  = 0.001) .The incidence of thrombosis (odd ratio [OR] 0.24, p  = 0.03) , new atrial fibrillation (odd ratio [OR] -0.17, p  = 0.04) , acute kidney injury (odd ratio [OR] 0.25, p  = 0.0005) and the need for transfusion (odd ratio [OR] 0.26, p  = 0.02) was statistically significant as well favoring the LMWH group recipients. Major bleeding and minor bleeding were similar between groups (p = 0.90, p= 0.47) respectively.

Conclusion(s): LMWH might be linked with favorable outcomes in thrombosis and ICU complications reduction in critically ill patients with COVID-19.