PB0043 - Optimal anticoagulation intensity for patients with COVID-19 treated with Tocilizumab

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Sotirios Bristogiannis, MD

Haematology Registrar
Evaggelismos General Hospital
Athens, Greece

Co-Author(s)

SP

Susi Paketci

Haematology SHO
The Hillingdon Hospitals NHS Foundation Trusts
London, England, United Kingdom
JM

Joel McCay

Haematology Registrar
The Hillingdon Hospitals NHS Foundation Trusts
London, England, United Kingdom
AD

Akila Danga

Haematology Consultant
The Hillingdon Hospitals NHS Foundation Trusts
London, England, United Kingdom
RH

Ruby Haji

Haematology Consultant
The Hillingdon Hospitals NHS Foundation Trusts
London, England, United Kingdom
KP

Ketan Patel

Haematology Consultant
The Hillingdon Hospitals NHS Foundation Trusts
London, England, United Kingdom
TS

Taku Sugai

Haematology Consultant
The Hillingdon Hospitals NHS Foundation Trusts
London, England, United Kingdom
RK

Richard Kaczmarski

Haematology Consultant
The Hillingdon Hospitals NHS Foundation Trusts
London, England, United Kingdom
Jecko Thachil, MD

Haematology Consultant
NHS Manchester University Hospital
Manchester, England, United Kingdom

Background: Tocilizumab reduces the need and the duration of organ support and provides a survival benefit for patients at the early stages of COVID-19 (Coronavirus Disease 2019) that have increasing oxygen needs and a significant inflammatory response. Contrary to expectations that this treatment would, also, break the vicious cycle of immunothrombosis of COVID-19, it has been debated whether it is associated with a conversely increased venous thromboembolism (VTE) incidence. In the interim, society guidelines have updated their recommendations advising a prophylactic over that of an intermediate or treatment dose of anticoagulation but there is a lack of evidence based for this group of patients.

Aims: The purpose of this study was to compare the incidence of VTEs in patients with COVID-19 treated with Tocilizumab in relationship to the thromboprophylaxis dose determined by NICE guidelines.

Methods: A retrospective, cohort study was performed including all patients with COVID-19 admitted at NHS Hillingdon Hospital (UK) who required Tocilizumab between December 2020 and September 2021.

Results: Sixty-three patients (20 females; 43 males) with a median age of 63 y.o. (17-83) were analysed (Table 1). A Spearman’s rank correlation was run to determine the relationship between the anticoagulation strategy and the thromboembolic risk in this context. A moderate negative correlation was found between the anticoagulation intensity and the risk of a VTE, r (61) = -0.470, p=0.000. Binary logistic regression was then used to determine the relationship between anticoagulation intensity and VTEs and Multinomial Logistic Regression for the opposite relationship. Treatment dose thromboprophylaxis is related with more VTEs however this is likely a reflection that patients with VTEs receive appropriate antithrombotic therapy (Table 2).

Conclusion(s): The present study suggests that patients with COVID-19 that receive Tocilizumab are not at increased thromboembolic risk and thus standard thromboprophylaxis should suffice. Findings should be confirmed in randomized controlled trials.