Anticoagulation strategies and clinical outcomes in critically ill SARS-CoV-2 patients: A retrospective cohort study

Background: COVID-19 is associated with a hypercoagulable state leading to an increased risk of thrombotic events. Although anticoagulation therapy is widely used, the optimal dosing strategy remains uncertain. Objective: The aim of this study was to evaluate the impact of therapeutic versus prophylactic anticoagulation on outcomes in critically ill COVID-19 patients. Methods: A retrospective cohort study was conducted on 315 critically ill COVID-19 patients. Patients were divided into two groups based on their anticoagulation regimen: therapeutic dose and prophylactic dose. The primary outcome was in-hospital mortality, while secondary outcomes included major bleeding events, thromboembolic events, and mechanical ventilation requirements. Results: No significant difference in mortality was observed between the therapeutic and prophylactic anticoagulation groups. Additionally, there were no significant differences in secondary outcomes. Conclusion: Our findings suggest that therapeutic anticoagulation may not provide a significant survival benefit compared to prophylactic anticoagulation in critically ill COVID-19 patients. To optimize patient outcomes, a more tailored approach to anticoagulation may be necessary, taking into account individual patient factors and risk assessment. Further prospective studies are needed to definitively establish the optimal anticoagulation strategy, especially in the context of evolving treatment modalities and vaccinations.