Impact of prophylactic anticoagulation on hospitalized COVID-19 patients aged over 80 years: a multicenter prospective cohort study

作者：Fengrong Xu, Guohui Fan, Jing Han, Yuzhi Tao, Lijun Chen, Yunhui Zhang, Binliang Wang, Chaosheng Deng, Weijia Liu, Yunxia Zhang, Zhu Zhang, Shuai Zhang, Yeming Wang, Jun Wan, Wanmu Xie, Peiran Yang, Wenbin Wu, Dingyi Wang, Chen Wang, Zhenguo Zhai · 发表于：European journal of medical research · 年份：2025 · DOI：10.1186/s40001-025-03041-0 · 被引用次数：2 · 研究领域：Venous Thromboembolism Diagnosis and Management、COVID-19 Clinical Research Studies、Heparin-Induced Thrombocytopenia and Thrombosis

BACKGROUND: Individuals aged 80 and older face a notably increased risk of venous thromboembolism (VTE) and mortality after SARS-CoV-2 infection. Clinical guidelines recommend routine pharmacological thromboprophylaxis, yet its application in oldest-old patients remains insufficiently studied. AIMS: To assess the efficacy and safety of low-molecular-weight heparin (LMWH) thromboprophylaxis in hospitalized COVID-19 patients aged 80 years and older. METHODS: We conducted a multicenter, prospective cohort study enrolling in-hospital COVID-19 patients aged ≥ 80 years from six tertiary hospitals in China between December 2022 and January 2023. The clinical outcomes were VTE, all-cause mortality and bleeding events. Patients were followed up for 3 months after discharge. Multivariate Cox regression models were used to identify risk factors and evaluate the impact of LMWH prophylaxis on clinical outcomes. RESULTS: Among 1526 patients aged ≥ 80 years, 41.6% received LMWH prophylaxis. LMWH prophylaxis significantly reduced VTE risk by 50% (HR 0.50, 95% CI 0.33-0.75) and mortality risk by 20% (HR 0.80, 95% CI 0.65-0.99), without increasing bleeding risk (HR 0.90, 95% CI 0.60-1.34). Male, history of stroke, critical illness on admission and hemoglobin < 90 g/L were identified as risk factors of bleeding. LMWH prophylaxis remained effective in preventing VTE and demonstrated favorable safety particularly in male patients and patients with hemoglobin < 90 g/L. DISCUSSION AND CONCLUSION: L...