PB0100 - Anticoagulation in hospitalized COVID-19 obese patients and venous thromboembolism (VTE) in Salvador – Brazil

Background: The choice of prophylactic anticoagulation varied widely in hospitalized COVID-19 patients during the pandemic. The heparin dose was frequently adjusted based on intensive level of care and also based on patients’ body weight.

Aims: To evaluate clinical outcomes, the choices of anticoagulants, and dose adjustments among hospitalized COVID-19 patients according to obesity.

Methods: A retrospective evaluation of COVID-19 patients admitted to a hospital in Salvador-Brazil from March 2020 to September 2021 and for whom diagnostic tests were performed for suspected VTE. The choice of anticoagulation is shown as percentages and compared between obese (BMI ≥ 30) and non-obese patients.

Results: 517 patients were included and 27.1% (140) were obese. Prophylactic anticoagulation was used in the first 48 hours in 395 patients: 90% (124) obese vs. 71% (192) non-obese patients (p < 0.0001), and pneumatic compression devices in 6.4% vs. 3.2% (p=0.13), table 2. The majority of patients used standard enoxaparin prophylaxis (58%); more obese patients received augmented dose enoxaparin 28% vs. 7.2%. Full dose anticoagulation, unfractionated heparin and rivaroxaban were infrequently used: 2.3%, 1.4% and 1.0% of all patients, respectively. 18.6% (96) developed VTE, with higher incidence in obese patients, 25% vs. 16.2% (p=0.03). Mortality was not significantly higher in obese patients, 17.1% vs. 13% (p=0.23). Clinical characteristics for obese and non-obese patients are shown in table 1. Significantly more obese patients had moderate-severe lung abnormalities, mechanical ventilation, central venous catheters, longer hospital-stay, intensive level of care use and cardiovascular comorbidities.

Conclusion(s): More obese patients received prophylactic anticoagulants and augmented doses of enoxaparin early after hospital admission. However, obesity was associated to increase risk of VTE events, longer hospitalization and critical care resources use among hospitalized COVID-19 patients.