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 establish the optimal anticoagulation strategy, especially in the context of evolving treatment modalities and vaccinations.