Long-term course of ambulatory patients with COVID-19 initially treated with enoxaparin vs no anticoagulation: final analysis of the OVID (enoxaparin for outpatients with COVID-19) randomized trial
oleh: Riccardo M. Fumagalli, Davide Voci, Behnood Bikdeli, Roland Bingisser, Giuseppe Colucci, Gabor Forgo, Teresa Gerardi, Bernhard Gerber, Alexandru Grigorean, Frederikus A. Klok, Marc Righini, Helia Robert-Ebadi, Stefan Stortecky, Silvia Ulrich, Simon Wolf, Dörte Wyss, Lukas Hobohm, Nils Kucher, Stefano Barco, Stefano Barco, Davide Voci, Ulrike Held, Tim Sebastian, Roland Bingisser, Giuseppe Colucci, Daniel Duerschmied, André Frenk, Bernhard Gerber, Andrea Götschi, Stavros V. Konstantinides, François Mach, Helia Robert-Ebadi, Thomas Rosemann, Noemi R. Simon, Hervé Spechbach, David Spirk, Stefan Stortecky, Lukas Vaisnora, Marc Righini, Nils Kucher, Stéphanie Roth Zetzsche, Rebecca Spescha, Claudia Leeger, Yulia Butscheid, Eliane Probst, Evy Micieli, Gabor Forgo, Fabian Johner, Alexandru Grigorean, Georgios Vatsakis, Dagmar Keller Lang, Silvana Rampini Speck, Barbara Hasse, Marco Rueegg, Isabelle Arnold, Christian Nickel, Jeannette Busch, Marc Blondon, Frédéric Glauser, Micol G. Cittone, Chiara Kessler, Diona Gjermeni, Christoph B. Olivier, Nadine Gauchel, Paul Biever, Lukas Hobohm, Dorothea Becker, Marc Schindewolf, Arnaud Kuenzi, Silvia Ulrich
| Format: | Article |
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| Diterbitkan: | Elsevier 2024-07-01 |
Deskripsi
Background: Early thromboprophylaxis does not prevent hospital admissions and death among outpatients with symptomatic COVID-19. Its impact on long-term outcomes, including long COVID symptoms and performance status, is unknown. Objectives: To assess the long-term effects of thromboprophylaxis given at the time of acute COVID-19 in outpatients. Methods: The OVID (enoxaparin for outpatients with COVID-19) trial randomized outpatients older than 50 years with acute COVID-19 to receive either subcutaneous enoxaparin 40 mg once daily for 14 days or standard of care (no thromboprophylaxis). In this follow-up study, we assessed the 2-year outcomes, including all-cause hospitalization and death, cardiovascular events, long COVID symptoms, and functional limitations based on the Post–COVID-19 Functional Status (PCFS) scale and EuroQol-5 Dimensions-5 Levels scale. Results: Of 469 potentially eligible patients, 468 survived, of whom 439 (mean age 59 years; 54% men) participated in the Post-OVID study. There was no difference in terms of hospitalization and death (8.3% in the treatment group vs 10% in controls; relative risk, 0.83; 95% CI, 0.5-1.5) and of cardiovascular events between groups. The risk of presenting with long COVID symptoms was similar in the 2 groups (44% in the treatment group vs 47% in the standard of care group), with no difference between groups also concerning individual symptoms. A PCFS grade of 1 to 3, indicating light-to-moderate functional limitation, was recorded in 15% of patients in each group (odds ratio, 0.98; 95% CI, 0.6-1.7). No patients reported severe limitations (PCFS grade 4). Median EuroQol visual analog scale score was 85 on 100 points (IQR, 80-90 for the standard of care group and 75-90 for the enoxaparin group). Conclusion: Early thromboprophylaxis does not improve long-term, 2-year clinical and functional outcomes among symptomatic ambulatory patients with acute COVID-19.