Efficacy and safety of preventive anticoagulation in patients with covid-19-pneumonia

Abstract

Purpose. Evaluation of the effectiveness and safety of the use of preventive or therapeutic doses of anticoagulants, depending on the risk of adverse outcome in patients with COVID-19-pneumonia. Materials and methods. An open prospective randomized continuous comparative study of 1004 patients with the proven diagnosis of coronavirus pneumonia was conducted. Patients were stratified to high and moderate risks of unfavorable outcome, according to clinical and laboratory parameters. In the main group with high risk, preemptive anticoagulant therapy was offered depending on the weight in intermediate and therapeutic dosages, in the control group – in preventive doses. In moderate risk of adverse outcome, prophylactic doses of anticoagulants were used in both groups. Control of outcomes was conducted in 1 month of observation. Results. The division of patients into subgroups and allocation of cohorts with high risk of adverse outcome lets to change the tactics of anticoagulant therapy timely, using therapeutic doses of drugs, if necessary, which reduces the frequency of thrombosis and mortality in the absence of a significant difference in the frequency of bleeding. Conclusions. The administration of “intermediate” and therapeutic doses of anticoagulants in the main group with high risk of unfavorable prognosis, taking into account the patient’s weight, led to decrease of the frequency of thrombosis from 40.9% in the control group to 14.6% in the main group (p=0.0001), and mortality – from 40.4% to 20.2% (p=0.0001). Changes in the management strategy of patients after stratification of the risk of unfavorable prognosis, proactive anticoagulant therapy let to increase the survival rate in the study from 85.7% in the control group to 91.1% in the main group (p=0.003).