Real-World Management of Pharmacological Thromboprophylactic Strategies for COVID-19 Patients in Japan: From the CLOT-COVID Study

• Published in: JACC. Asia 2022-12, Vol.2 (7), p.897-907
• Main Authors: Hayashi, Hiroya, Izumiya, Yasuhiro, Fukuda, Daiju, Wakita, Fumiaki, Mizobata, Yasumitsu, Fujii, Hiromichi, Yachi, Sen, Takeyama, Makoto, Nishimoto, Yuji, Tsujino, Ichizo, Nakamura, Junichi, Yamamoto, Naoto, Nakata, Hiroko, Ikeda, Satoshi, Umetsu, Michihisa, Aikawa, Shizu, Satokawa, Hirono, Okuno, Yoshinori, Iwata, Eriko, Ogihara, Yoshito, Ikeda, Nobutaka, Kondo, Akane, Iwai, Takehisa, Yamada, Norikazu, Ogawa, Tomohiro, Kobayashi, Takao, Mo, Makoto, Yamashita, Yugo
• Format: Article
• Language: English
• Subjects: Original Research
• ISSN: 2772-3747
• DOI: 10.1016/j.jacasi.2022.09.005

Data on prophylactic anticoagulation are important in understanding the current issues, unmet needs, and optimal management of Japanese COVID-19 patients. This study aimed to investigate the clinical management strategies for prophylactic anticoagulation of COVID-19 patients in Japan. The CLOT-COVID study was a multicenter observational study that enrolled 2,894 consecutive hospitalized patients with COVID-19. The study population consisted of 2,889 patients (after excluding 5 patients with missing data); it was divided into 2 groups: patients with pharmacological thromboprophylaxis (n = 1,240) and those without (n = 1,649). Furthermore, we evaluated the 1,233 patients who received prophylactic anticoagulation-excluding 7 patients who could not be classified based on the intensity of their anticoagulants-who were then divided into 2 groups: patients receiving prophylactic anticoagulant doses (n = 889) and therapeutic anticoagulant doses (n = 344). The most common pharmacological thromboprophylaxis anticoagulant was unfractionated heparin (68.2%). The severity of COVID-19 at admission was a predictor of the implementation of pharmacological thromboprophylaxis in the multivariable analysis (moderate vs mild: OR: 16.6; 95% CI:13.2-21.0;  < 0.001, severe vs mild: OR: 342.6, 95% CI: 107.7-1090.2;  < 0.001). It was also a predictor of the usage of anticoagulants of therapeutic doses in the multivariable analysis (moderate vs mild: OR: 2.10; 95% CI: 1.46-3.02;  < 0.001, severe vs mild: OR: 5.96; 95% CI: 3.91-9.09;