Beneficial Effects of Intermediate Dosage of Anticoagulation Treatment on the Prognosis of Hospitalized COVID-19 Patients: The ETHRA Study
Garyphallia Poulakou, Evangelos Dimakakos, Αναστάσιος Κόλλιας, Konstantinos G. Kyriakoulis, Vasiliki Rapti, Ioannis P. Trontzas, CHARALAMPOS THANOS, Mahmoud Abdel‐Rasoul, THEODORA VANTANA, Konstantinos Leontis, Eleni Kakalou, Katerina Argyraki, Ioannis G. Baraboutis, Evangelos D. Michelakis, Evangelos J. Giamarellos‐Bourboulis, Katerina Dimakou, Georgios Tsoukalas, A. Rapti, Evangelos D. Michelakis, Konstantinos N. Syrigos
Abstract
BACKGROUND/AIM: To investigate the efficacy (prognosis, coagulation/inflammation biomarkers) and safety (bleeding events) of different anticoagulation dosages in COVID-19 inpatients. PATIENTS AND METHODS: COVID-19 inpatients (Athens, Greece) were included. The "Enhanced dose THRomboprophylaxis in Admissions (ETHRA)" protocol was applied in certain Departments, suggesting the use of intermediate anticoagulation dosage. The primary endpoint was a composite of intubation/venous thromboembolism/death. Inflammation/coagulation parameters were assessed. RESULTS: Among 127 admissions, 95 fulfilled the inclusion criteria. Twenty-one events (4 deaths, 17 intubations) were observed. Regression analysis demonstrated significant reduction of events with intermediate or therapeutic dosage [HR=0.16 (95%CI=0.05-0.52) p=0.002; HR=0.17 (0.04-0.71) p=0.015, respectively]. D-Dimer values were higher in those who met the composite endpoint. Intermediate dosage treatment was associated with decreased values of ferritin. Three patients (3%) had minor hemorrhagic complications. CONCLUSION: Anticoagulation treatment (particularly intermediate dosage) appears to have positive impact on COVID-19 inpatients' prognosis by inhibiting both coagulation and inflammatory cascades.