AUTHOR=Alrashed Ahmed , Cahusac Peter , Mohzari Yahya A. , Bamogaddam Reem F. , Alfaifi Mashael , Mathew Maya , Alrumayyan Bashayer F. , Alqahtani Basmah F. , Alshammari Amjad , AlNekhilan Kholud , Binrokan Aljawharah , Alamri Khalil , Alshahrani Abdullah , Alshahrani Safar , Alanazi Ahmad S. , Alhassan Batool M. , Alsaeed Ali , Almutairi Wedad , Albujaidy Asma , AlJuaid Lama , Almalki Ziyad S. , Ahmed Nehad , Alajami Hamdan N. , Aljishi Hala M. , Alsheef Mohammed , Alajlan Saleh A. , Almutairi Faisal , Alsirhani Atheer , Alotaibi Manayer , Aljaber Melaf A. , Bahammam Hammam A. , Aldandan Hussain , Almulhim Abdulaziz S. , Abraham Ivo , Alamer Ahmad 

TITLE=A comparison of three thromboprophylaxis regimens in critically ill COVID-19 patients: An analysis of real-world data

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.978420

DOI=10.3389/fcvm.2022.978420

ISSN=2297-055X

ABSTRACT=Introduction: Thrombotic complications of coronavirus disease 2019 (COVID-19) have received considerable attention. Although numerous conflicting findings have compared escalated thromboprophylaxis doses with a standard dose to prevent thrombosis, there are no reports that compare three different anticoagulation dosing regimens simultaneously. Thus, we investigated the effectiveness and safety profiles of standard, intermediate, and high-anti-coagulation dosing strategies in critically ill patients.
Methodology: This retrospective multicenter cohort study of intensive care unit (ICU) patients from the period of April 2020 to August 2021in four Saudi Arabian centers. The primary endpoint was a composite of thrombotic events, with mortality rate and minor or major bleeding serving as secondary endpoints. We applied survival analyses with a matching weights procedure to control for confounding variables in the three arms. 
Results: A total of 811 patient records were reviewed, with 551 (standard-dose = 192, intermediate-dose = 180, and high-dose = 179) included in the analysis. After using weights matching, we found that the standard-dose group was not associated with an increase in the composite thrombotic events endpoint when compared to the intermediate-dose group (19.8% vs 25%; adjusted hazard ratio (aHR), 1.46, [95% confidence of interval (CI), 0.94 to 2.26]) or when compared to high-dose group (19.8% vs 24%; aHR, 1.22 [95% CI, 0.88 to 1.72]). Also, there were no statistically significant differences between standard, intermediate, or high-dosing groups concerning the overall in-hospital mortality (51% vs 53.4% vs 61.1%, respectively; P=0.354). Moreover, the risk of major bleeding was comparable in all three groups (standard: 4.8% vs intermediate: 2.8% vs high: 9%; P=0.115). However, intermediate-dose and high-dose were both associated with an increase in minor bleeding incidence with aHR; 2.9 [95% CI, 1.26 to 6.80 and aHR: 3.9 (95% CI, 1.73 to 8.76); respectively.  
Conclusion: Among COVID-19 patients admitted to the ICU, neither of the three dosing regimens differed for the composite of thrombotic events and mortality. Compared with the standard-dose regimen, intermediate and high-dosing thromboprophylaxis were associated with a higher risk of minor but not major bleeding. Thus, these data recommend a standard dose as the preferred regimen.