15 February 2021

COVID-19 patients who were given prophylactic anticoagulants within 24 hours of admission to hospital were less likely to die, compared with those who did not receive the blood thinners, according to a study published last week.

The US and UK researchers say their findings from their observational study provide strong real-world evidence to support the early use of prophylactic anticoagulants in hospitalised COVID-19 patients, while randomised clinical trials are in progress.

Because results from previous studies into the efficacy of anticoagulants for COVID-19 patients have been inconclusive, the researchers examined the effect of prophylactic anticoagulants when they were given quickly to a patient when admitted to hospital.

The findings are reported in the latest edition of The BMJ.

The research team analysed data from the United States Department of Veterans Affairs for 4,297 patients who were admitted to hospital with COVID-19 between 1st March and 31st July 2020.  The average age of the patients was 68 years and 93% were men.

The researchers followed their progress to see who died or experienced a serious bleeding event within 30 days of hospital admission. Potentially important factors including age, ethnicity, underlying conditions, medication history, weight, and smoking status were taken into account.

They found that out of the 4,297 patients analysed, 3,627 (84.4%) received prophylactic anticoagulation within 24 hours of admission and there were 622 deaths (14.5%) within 30 days.

Death at 30 days was 14.3% among those who received prophylactic anticoagulation compared with 18.7% among those who did not. This equates to a relative risk reduction of 27% and an absolute risk reduction of 4.4%.

The researchers found a greater benefit of receiving prophylactic anticoagulation among patients not admitted to the intensive care unit within 24 hours of hospital admission. There was no association with an increased risk of serious bleeding.

They write that because it was an observational study, randomised trials are needed to assess the drugs’ effectiveness, but add it was a large, well-designed study using electronic health record data that took account of a range of potential confounding factors.

They conclude their findings “provide strong real-world evidence to support guidelines recommending the use of prophylactic anticoagulation as initial treatment for patients with COVID-19 on hospital admission” until further clinical trial evidence is produced.


Rentsch CT, Beckman JA, Tomlinson L, Gellad WF, Alcorn C, Kidwai-Khan F, Skanderson M, Brittain E, King JT Jr, Ho YL, Eden S, Kundu S, Lann MF, Greevy RA Jr, Ho PM, Heidenreich PA, Jacobson DA, Douglas IJ, Tate JP, Evans SJW, Atkins D, Justice AC, Freiberg MS (2021) “Early initiation of prophylactic anticoagulation for prevention of coronavirus disease 2019 mortality in patients admitted to hospital in the United States: cohort study.” BMJ, doi: 10.1136/bmj.n311


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