Therapeutic versus Prophylactic Anticoagulation with Low Molecular Weight Heparin for Moderate COVID-19 Patients

Background: COVID-19 is linked to an increased susceptibility to thrombotic problems, but the effectiveness of therapeutic-dose anticoagulation is uncertain. The aim was to detect whether the therapeutic-dose anticoagulation improves clinical status of moderate Covid 19 patients in comparison to prophylactic dose anticoagulation. Methods: The protocol for this trial was approved by the institutional review board of Menoufia university (trial registration No.:12/2021 ANET 23). This study is a prospective randomized comparative trial included 70 patients with moderate COVID-19 assigned into group A (receiving therapeutic anticoagulation with subcutaneous low-molecular-weight heparin (LMWH) at a dose of 1 mg/kg twice daily) and group B (receiving thromboprophylaxis with subcutaneous LMWH at a dose of 40 mg once daily). The aim was to assess the clinical status on an ordinal scale of 8 points from world health organization. Results: Patients on group A were well matched with the patients on group B regarding the efficacy outcome (clinical status assessed by World Health Organization (WHO), laboratory data , 28-day mortality and the length of hospital stay) except the D-dimer level at week 2 that was elevated in group B than in the group A (2200 vs 1100 ng/mL, P<0.05), as well as the result of PaO2/FiO2 which were higher on week 2 in group A (190 vs 145 respectively, P<0.05). Conclusion: The prophylactic anticoagulation had priority over the therapeutic one in the treatment of moderate COVID-19 individuals as the therapeutic dose had no impact on either the clinical status assessed by WHO scale or overall mortality rate.