Background: Tocilizumab reduces the need and the duration of organ support and provides a survival benefit for patients at the early stages of COVID-19 (Coronavirus Disease 2019) that have increasing oxygen needs and a significant inflammatory response. Contrary to expectations that this treatment would, also, break the vicious cycle of immunothrombosis of COVID-19, it has been debated whether it is associated with a conversely increased venous thromboembolism (VTE) incidence. In the interim, society guidelines have updated their recommendations advising a prophylactic over that of an intermediate or treatment dose of anticoagulation but there is a lack of evidence based for this group of patients.

Aims: The purpose of this study was to compare the incidence of VTEs in patients with COVID-19 treated with Tocilizumab in relationship to the thromboprophylaxis dose determined by NICE guidelines.

Methods: A retrospective, cohort study was performed including all patients with COVID-19 admitted at NHS Hillingdon Hospital (UK) who required Tocilizumab between December 2020 and September 2021.

Results: Sixty-three patients (20 females; 43 males) with a median age of 63 y.o. (17-83) were analysed (Table 1). A Spearman’s rank correlation was run to determine the relationship between the anticoagulation strategy and the thromboembolic risk in this context. A moderate negative correlation was found between the anticoagulation intensity and the risk of a VTE, r (61) = -0.470, p=0.000. Binary logistic regression was then used to determine the relationship between anticoagulation intensity and VTEs and Multinomial Logistic Regression for the opposite relationship. Treatment dose thromboprophylaxis is related with more VTEs however this is likely a reflection that patients with VTEs receive appropriate antithrombotic therapy (Table 2).

Conclusion(s): The present study suggests that patients with COVID-19 that receive Tocilizumab are not at increased thromboembolic risk and thus standard thromboprophylaxis should suffice. Findings should be confirmed in randomized controlled trials.

Table 1

Patient Characteristics.*These categories have missing patient data. The exponent refers to the number of missing patient data. DM2: Diabetes Mellitus Type II, CHF: Chronic Heart Failure, CAD: Coronary Artery Disease, AF: Atrial Fibrillation, COPD: Chronic Obstructive Pulmonary Disease, Obesity; Hx pVTE: History of previous Venous Thromboembolism

Table 2

2a.Binary logistic regression results for the relationship of the incidence of thromboembolic events to the intensity of anticoagulation. ‘Prophylactic’ Anticoagulation is the reference category.
2b.Multinomial logistic regression results for the relationship of the anticoagulation intensity to the thromboembolic events. ‘Prophylactic’ Anticoagulation is the reference category

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/optimal-anticoagulation-intensity-for-patients-with-covid-19-treated-with-tocilizumab/