Evaluating the Effectiveness of NOAC and LMWHs in Reducing Mortality in Critically Ill Patients with COVID-19

Background Severe COVID-19 is associated with increased prothrombotic and inflammatory responses, necessitating effective anticoagulation therapy. Novel oral anticoagulants (NOACs) are being explored as alternatives to low-molecular-weight heparin (LMWH). Methods This retrospective cohort study compared the effectiveness and safety of NOACs and LMWH in reducing mortality among 76 critically ill, unvaccinated patients with confirmed SARS-CoV-2 infection. The cohort included 41 patients treated with LMWH and 35 with NOACs during their ICU stay. The primary outcomes focused on mortality, with secondary outcomes including deep vein thrombosis (DVT), bleeding episodes, and transfusion rates. Results Baseline characteristics, including demographic data and severity scores, were similar between the groups (mean age: LMWH, 74.5 ± 15.1 years [59% male]; NOAC, 71.6 ± 14.8 years [60% male]). Mortality was significantly greater in the LMWH group (51.21% [95% confidence interval (CI): 36.4–65.7]) than in the NOAC group (20% [95% CI: 10.0–35.9]; p = 0.005), with standardized mortality ratios of 1.61 and 0.71, respectively (p = 0.004). Elevated D-dimer levels are strongly associated with increased mortality risk. DVT occurred in 9.76% of LMWH patients and 5.71% of NOAC patients (p = 0.68). The bleeding and transfusion rates were comparable between the groups. Conclusions NOACs were associated with a significantly lower mortality rate than LMWHs in critically ill COVID-19 patients, reflecting an 81% reduced risk of death. These findings highlight the potential advantages of NOACs in managing severe COVID-19 and underscore the need for further research to optimize anticoagulation therapy and improve patient outcomes.