Beneficial Effects of Intermediate Dosage of Anticoagulation Treatment on the Prognosis of Hospitalized COVID-19 Patients: The ETHRA Study

• Published in: In vivo (Athens) Vol. 35; no. 1; pp. 653 - 661
• Main Authors: Poulakou, Garyphallia, Dimakakos, Evangelos, Kollias, Anastasios, Kyriakoulis, Konstantinos G, Rapti, Vasiliki, Trontzas, Ioannis, Thanos, Charalampos, Abdelrasoul, Mahmoud, Vantana, Theodora, Leontis, Konstantinos, Kakalou, Eleni, Argyraki, Katerina, Baraboutis, Ioannis, Michelakis, Evangelos, Giamarellos-Bourboulis, Evangelos, Dimakou, Katerina, Tsoukalas, Georgios, Rapti, Angeliki, Michelakis, Evangelos D, Syrigos, Konstantinos N
• Format: Journal Article
• Language: English
• Published: Greece International Institute of Anticancer Research 01.01.2021
• Subjects: Adult; Aged; Aged, 80 and over; Anticoagulants - administration & dosage; Anticoagulants - therapeutic use; Blood Coagulation - drug effects; COVID-19 - blood; COVID-19 - prevention & control; COVID-19 - virology; Dose-Response Relationship, Drug; Female; Greece; Hospitalization - statistics & numerical data; Humans; Inpatients - statistics & numerical data; Male; Middle Aged; Retrospective Studies; SARS-CoV-2 - isolation & purification; SARS-CoV-2 - physiology; Treatment Outcome; Venous Thromboembolism - blood; Venous Thromboembolism - drug therapy; Greece; COVID-19; prognosis; intermediate dosage; anticoagulation; thromboprophylaxis
• ISSN: 0258-851X; 1791-7549
• DOI: 10.21873/INVIVO.12305

To investigate the efficacy (prognosis, coagulation/inflammation biomarkers) and safety (bleeding events) of different anticoagulation dosages in COVID-19 inpatients. 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. 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. Anticoagulation treatment (particularly intermediate dosage) appears to have positive impact on COVID-19 inpatients' prognosis by inhibiting both coagulation and inflammatory cascades.