Low in-hospital mortality rate in patients with COVID-19 receiving thromboprophylaxis: data from the multicentre observational START-COVID Register
Daniela Poli, Emilia Antonucci, Walter Ageno, Paolo Prandoni, Gualtiero Palareti, Rossella Marcucci, the START-COVID Investigators, Rossella Marcucci, Daniela Poli, Walter Ageno, Giovanna Colombo, Chiara Ambaglio, Guido Arpaia, Giovanni Barillari, Giuseppina Bitti, Eugenio Bucherini, Antonio Chistolini, Alessandra Serrao, Egidio De Gaudenzi, Valeria Micheli, Anna Falanga, Teresa Lerede, Luca Barcella, Laura Russo, Silvia Galliazzo, Alberto Gandolfo, Gianni Biolo, Valentina Trapletti, G Ghigliotti, Elisa Grifoni, Luca Masotti, Egidio Imbalzano, Gianfranco Lessiani, Niccolò Marchionni, Giuliana Martini, Sara Merelli, Franco Mastroianni, Giovanni Larizza, Carlo Nozzoli, Serena Panarello, Chiara Fioravanti, Simona Pedrini, Federica Bertola, Raffaele Pesavento, Filippo Pieralli, Pasquale Pignatelli, Daniele Pastori, Paola Preti, Elias Romano, A Morettini, Girolamo Sala, Fabrizio Foieni, Michela Provisone, Luca Sarti, Antonella Caronna, Federico Simonetti, Ilaria Bertaggia, Piera Sivera, Carmen Fava, Viviana Scancassani, Michele Spinicci, A. Bartoloni, A. Visonà, Beniamino Zalunardo, Sabina Villalta
Abstract
COVID-19 infection causes respiratory pathology with severe interstitial pneumonia and extra-pulmonary complications; in particular, it may predispose to thromboembolic disease. The current guidelines recommend the use of thromboprophylaxis in patients with COVID-19, however, the optimal heparin dosage treatment is not well-established. We conducted a multicentre, Italian, retrospective, observational study on COVID-19 patients admitted to ordinary wards, to describe clinical characteristic of patients at admission, bleeding and thrombotic events occurring during hospital stay. The strategies used for thromboprophylaxis and its role on patient outcome were, also, described. 1091 patients hospitalized were included in the START-COVID-19 Register. During hospital stay, 769 (70.7%) patients were treated with antithrombotic drugs: low molecular weight heparin (the great majority enoxaparin), fondaparinux, or unfractioned heparin. These patients were more frequently affected by comorbidities, such as hypertension, atrial fibrillation, previous thromboembolism, neurological disease, and cancer with respect to patients who did not receive thromboprophylaxis. During hospital stay, 1.2% patients had a major bleeding event. All patients were treated with antithrombotic drugs; 5.4%, had venous thromboembolism [30.5% deep vein thrombosis (DVT), 66.1% pulmonary embolism (PE), and 3.4% patients had DVT + PE]. In our cohort the mortality rate was 18.3%. Heparin use was independently associated with survival in patients aged ≥ 59 years at multivariable analysis. We confirmed the high mortality rate of COVID-19 in hospitalized patients in ordinary wards. Treatment with antithrombotic drugs is significantly associated with a reduction of mortality rates especially in patients older than 59 years.