Real World Outcomes of Therapeutic Anticoagulation Use in Moderate COVID-19 Infection in Hospitalised Patients

Background For patients hospitalised with moderate COVID-19, the use of therapeutic-dose heparin increases the probability of survival to hospital discharge compared with intermediate or standard prophylactic dose thromboprophylaxis (1-3). However, due to concerns of bleeding, there has been hesitancy to use therapeutic anticoagulation for these patients.

Aim To audit the "real world' incidence of bleeding and transfusion requirement in patients receiving therapeutic anticoagulation whilst hospitalised with moderate severity COVID-19 infection.

Methods Records from a random sample of patients admitted to a single hospital between September 2021 and January 2022 and who tested positive for COVID-19 were retrospectively audited. Baseline demographics, COVID-19 variant, vaccination status, co-morbidities, concurrent antiplatelet use, haemoglobin, incidence of bleeding and venous thromboembolism, transfusion support, length of stay, and in-hospital mortality data were collected from electronic databases. Hospital approval for the audit was obtained prior to the project's commencement.

Results A total of 1304 patients were admitted and tested positive for COVID-19 infection during the study period. Of these, 364 patients were audited. 231 patients had mild infection (63% of those audited), 80 (22%) had moderate, and 53 (15%) had severe. See table 1 for details. Of the 80 patients with moderate severity,45 (12% of those audited) received therapeutic anticoagulation in accordance with the hospital's thromboprophylaxis guideline. Within these 45 patients, none suffered from in hospital bleeding complications. However, 4 (1% of those audited) patients required red cell transfusion, 3 (1% of those audited) of whom required transfusion due to sickle cell crisis management and one for post chemotherapy anaemia.

Conclusion This real-world study demonstrates that therapeutic anticoagulation for moderate severity COVID-19 infection is reassuringly not associated with high rates of bleeding. Indications for transfusion in this group was due to other co-morbidities.

References 1. Lawler PR, Goligher EC, Neal MD, McVerry BJ, Nicolau JC, Gong MN, et al. Therapeutic Anticoagulation with Heparin in Noncritically Ill Patients with Covid-19. The New England journal of medicine. 2021;385:790-802

2. Goligher EC, Bradbury CA, McVerry BJ, Lawler PR, Berger JS, Carrier M, et al. Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19. The New England journal of medicine. 2021;385:777-89

3. Ramacciotti E, Barile Agati L, Calderaro D, Aguiar VCR, Spyropoulos AC, de Oliveira CCC, et al. Rivaroxaban versus no anticoagulation for post-discharge thromboprophylaxis after hospitalisation for COVID-19 (MICHELLE): an open-label, multicentre, randomised, controlled trial. The Lancet. 2022;399(10319):50-9.

Breen:Veniti: Honoraria; Bayer: Honoraria.