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Hypercoagulability is a common complication of the systemic inflammation related to coronavirus disease 2019 creating debate within the critical care community on the therapeutic utility of Low Molecular Weight Heparin (LMWH). We collected data on consecutive patients with COVID-19 admitted to the Emergency Department of Castel San Giovanni Hospital, between February 29th and April 7th, 2020. Exclusion criteria were age

Objective To evaluate the role of low molecular weight heparin in COVID-19 treatment.Design Retrospective cohort studySetting Patients with COVID-19 pneumonia consecutively admitted to Castel San Giovanni COVID- Hospital from February 29, to April 7, 2020.Main outcome measure Hospital mortality and safety in patients treated with low molecular weight hep- arin.Results Of the 257 patients enrolled, 49 (19.1%) died during the hospitalization. Hospital mortality was significantly lower in patients treated with therapeutic dose of low molecular weight heparin (T-LMWH) (17/126, 13.5%), compared with patients treated with prophylactic dose (P-LMWH) (32/131, 24.4%; χ²=4.98, p = 0.02). Crude and adjusted odds ratios of mortality for patients treated with T-LMWH were OR=0.483, 95% CI 0.252-0.923 and OR=0.374, 95% CI 0.177-0.792. In a stratified analysis by ventila- tion type, the only subgroup of patients who benefited from therapeutic doses of heparin were those re- ceiving non-invasive mechanical ventilation (OR=0.099, 95% CI 0.028-0.354, pConclusion Treatment with therapeutic doses of T-LMWH is safe and seems to reduce mortality in COVID-19 patients with pneumonia, especially among those who need non-invasive mechanical ventila- tion. We look forward to prospective studies to confirm this observation and evaluate the appropriate dose of LMWH in the treatment of COVID-19 patients.