Low in-hospital mortality rate in patients with COVID-19 receiving thromboprophylaxis: data from the multicentre observational START-COVID Register
Authors: Poli Daniela , Antonucci Emilia , Ageno Walter , Prandoni Paolo , Palareti Gualtiero , Marcucci Rossella ,   the START-COVID Investigators, Marcucci Rossella , Poli Daniela , Ageno Walter , Colombo Giovanna , Ambaglio Chiara , Arpaia Guido , Barillari Giovanni , Bitti Giuseppina , Bucherini Eugenio , Chistolini Antonio , Serrao Alessandra , De Gaudenzi Egidio , De Micheli Valeria , Falanga Anna , Lerede Teresa , Barcella Luca , Russo Laura , Galliazzo Silvia , Gandolfo Alberto , Biolo Gianni , Trapletti Valentina , Ghigliotti Giorgio , Grifoni Elisa , Masotti Luca , Imbalzano Egidio , Lessiani Gianfranco , Marchionni Niccolò , Martini Giuliana , Merelli Sara , Mastroianni Franco , Larizza Giovanni , Nozzoli Carlo , Panarello Serena , Fioravanti Chiara , Pedrini Simona , Bertola Federica , Pesavento Raffaele , Pieralli Filippo , Pignatelli Pasquale , Pastori Daniele , Preti Paola , Romano Elias , Morettini Alessandro , Sala Girolamo , Foieni Fabrizio , Provisone Michela , Sarti Luca , Caronna Antonella , Simonetti Federico , Bertaggia Ilaria , Sivera Piera , Fava Carmen , Scancassani Viviana , Spinicci Michele , Bartoloni Alessio , Visonà Adriana , Zalunardo Beniamino , Villalta Sabina 
Published: January 2022

AbstractCOVID-19 infection causes respiratory pathology with severe interstitial pneumonia and extra-pulmonary complications; in particular, it may predispose to thromboembolic disease. The current guidelines recommend the use of thromboprophylaxis in patients with COVID-19, however, the optimal heparin dosage treatment is not well-established. We conducted a multicentre, Italian, retrospective, observational study on COVID-19 patients admitted to ordinary wards, to describe clinical characteristic of patients at admission, bleeding and thrombotic events occurring during hospital stay. The strategies used for thromboprophylaxis and its role on patient outcome were, also, described. 1091 patients hospitalized were included in the START-COVID-19 Register. During hospital stay, 769 (70.7%) patients were treated with antithrombotic drugs: low molecular weight heparin (the great majority enoxaparin), fondaparinux, or unfractioned heparin. These patients were more frequently affected by comorbidities, such as hypertension, atrial fibrillation, previous thromboembolism, neurological disease, and cancer with respect to patients who did not receive thromboprophylaxis. During hospital stay, 1.2% patients had a major bleeding event. All patients were treated with antithrombotic drugs; 5.4%, had venous thromboembolism [30.5% deep vein thrombosis (DVT), 66.1% pulmonary embolism (PE), and 3.4% patients had DVT + PE]. In our cohort the mortality rate was 18.3%. Heparin use was independently associated with survival in patients aged ≥ 59 years at multivariable analysis. We confirmed the high mortality rate of COVID-19 in hospitalized patients in ordinary wards. Treatment with antithrombotic drugs is significantly associated with a reduction of mortality rates especially in patients older than 59 years.