Key result
Outpatient LMWH linked to ~65% lower mortality in high-risk COVID-19 patients.
Why the study?
Does pre-admission outpatient low-molecular-weight heparin improve clinical outcomes in high-risk COVID-19 patients?
Observational (n=1,189)
No
Does pre-admission outpatient low-molecular-weight heparin improve clinical outcomes in high-risk COVID-19 patients?
Answers are grounded in this paper and cite their sources.
Early outpatient administration of LMWH in high-risk COVID-19 patients is associated with reduced mortality, shorter hospital stays, and decreased need for respiratory support.
BACKGROUND: Covid-19 and venous thromboembolism (VTE) share risk factors and thrombo-inflammatory pathophysiology. In-hospital low-molecular-weight heparin (LMWH) use improved outcomes. Before vaccinations or available treatments, the Helsinki university hospital in Finland, initiated LMWH thromboprophylaxis to Covid-19 outpatients with progressing illness and high-risk of VTE (LMWH+ group), aligning with the existing in-hospital guidance for thromboprophylaxis. METHODS: We observationally studied whether pre-admission LMWH thromboprophylaxis impacted outcomes: hospital and ICU stay, and respiratory support after Covid-19 hospitalization. We compared control group (LMWH-) by propensity score-matching comorbidities, medications and Covid-19 severity and VTE risk with the LMWH+ group with 30-day follow-up. RESULTS: Among 1189 hospitalized patients, 241 were stratified in the LMWH+ group and 482 were propensity-matched into the LMWH- group. The mean time (±SD) from Covid-19 diagnosis until outpatient thromboprophylaxis in the LMWH+ group was 1.9 (±3.0) days; ~80 % of patients received thromboprophylaxis ≤2 days after the diagnosis. Longer duration of pre-admission LMWH use was associated with shorter hospital stays and less days with respiratory support (p < 0.006-0.008). The incidences of bleeds and VTE (LMWH+ 4.6 %, LMWH- 5.4 %) were similar. Overall, 2.9-fold higher mortality (p = 0.014) occurred in the LMWH- (10.6 %) versus the LMWH+ group (3.7 %). CONCLUSIONS: Outpatient LMWH given pre-admission for high-risk Covid-19 patients was associated with improved outcome following diagnosis: shorter respiratory support and hospital stay with reduced need for intensive care. Our findings support early initiation of LMWH in risk-stratified patients to manage thrombo-inflammation. While being Covid-19 aftermath, our study is relevant for any other severe viral outbursts associated with thrombogenicity.
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Koskinen et al. (2025) conducted an observational in Covid-19 (n=1,189). Low-molecular-weight heparin (LMWH) vs. No pre-admission LMWH was evaluated on Mortality (p=0.014). Pre-admission outpatient use of low-molecular-weight heparin in high-risk Covid-19 patients was associated with lower mortality compared to matched controls (3.7% vs 10.6%, p=0.014).
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