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Abstract Coronavirus disease 2019 (Covid-19) is an illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). It primarily affects the lungs resulting in inflammation and pneumonia. Covid-19 is associated with a higher risk of thrombotic complications and a greater magnitude of these events than are other respiratory infections. A thromboinflammatory state, associated with endothelial dysfunction, hypercoagulability, and coagulation activation, leads to an increased risk of microvascular and macrovascular thrombosis. These thrombotic complications include arterial and venous events, with microvascular thrombosis possibly contributing to the diffuse lung injury seen in patients with COVID-19. Given the reports of excess thrombotic risk, enhanced-dose anticoagulation strategies have been incorporated into some Covid-19 guidance statements, especially for critically ill patients. However, the effectiveness and safety of therapeutic-dose anticoagulation given to improve outcomes in Covid-19 are uncertain. Summary of our results: regarding the baseline data there was no statistically significant difference detected between both treatment arms regarding baseline characteristics (age, sex distribution, BMI, comorbidities, time from symptoms onset and baseline laboratory data (Hb, PLT, creatinine, BUN, ALT, INR, D-dimer, ferritin, procalcitonin, CRP and PaO2/FiO2). Regarding the efficacy outcome by clinical status assessed by the ordinal scale of who, there was no statistically significant difference between both groups at any time point for 2 weeks. Regarding CBC test results, kidney function tests, ALT, ferritin, procalcitonin, CRP and INR evidenced no statically significant difference between both groups at any timepoint for 2 weeks. As for D-dimer, it was insignificantly different at baseline and after one week, meanwhile, we observed a significant difference after 2 weeks as it was lower in therapeutic anticoagulation group compared to the prophylactic anticoagulation one. Regarding ABG, PaO2/FiO2 level was insignificantly different between both groups at baseline and after one week but after 2 weeks, patients on therapeutic dose anticoagulation elicited significantly increased PaO2/FiO2 ratio than those on prophylactic dose anticoagulation. The incidence of thromboembolic events was insignificantly different between both groups at any time point for 2 weeks. Regarding 28-day mortality, we didn’t observe any statistically significant difference between both groups. Regarding the need for MV, renal replacement therapy, vasopressor need, and length of hospital stay there was no statistically significant difference between both groups. Regarding major bleeding, only 8.6% of the therapeutic anticoagulation group experienced major bleeding, with no statistically significant difference between both groups. Kaplan Meier analysis showed that patients on therapeutic-dose anticoagulation had a slightly lower probability of mortality than those on prophylactic-dose anticoagulation, but with no statistically significant difference. In both groups, there was a significant positive correlation between WHO ordinal scale for clinical status and each of INR, D-dimer, ferritin, procalcitonin and CRP after 2 weeks of treatment. On the other hand, there was a significant negative correlation between WHO scale and PaO2/FiO2. |