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. 2020 Dec:196:313-317.
doi: 10.1016/j.thromres.2020.09.013. Epub 2020 Sep 13.

Venous thromboembolism and bleeding in critically ill COVID-19 patients treated with higher than standard low molecular weight heparin doses and aspirin: A call to action

Vittorio Pavoni  1 , Lara Gianesello  2 , Maddalena Pazzi  1 , Caterina Stera  1 , Tommaso Meconi  1 , Francesca Covani Frigieri  1
Affiliations

Venous thromboembolism and bleeding in critically ill COVID-19 patients treated with higher than standard low molecular weight heparin doses and aspirin: A call to action

Vittorio Pavoni et al. Thromb Res. 2020 Dec.

Abstract

Background: Critically ill COVID-19 patients have a clear pattern of inflammation and hypercoagulable state. The main aim of the study was to evaluate the outcome of severe COVID-19 patients basing on prothrombotic risk factors (i.e. D-dimer). We also evaluated the impact of different doses of low molecular weight heparin (LMWH) on the incidence of bleedings.

Methods: The data of forty-two patients admitted to the Intensive Care Unit (ICU) were retrospectively analyzed. On ICU admission, patients with D-dimer < 3000 ng/mL (Group 1) received enoxaparin 4000 UI (6000 UI, if body mass index >35) subcutaneously b.i.d. and patients with D-dimer ≥ 3000 ng/mL (Group 2) received enoxaparin 100 UI/kg every 12 h. Aspirin was administered to all patients once a day.

Results: Both groups presented a high incidence of perivascular thrombosis (40.9% in Group 1 and 30% in Group 2). Patients of Group 2 suffered a higher incidence of venous thromboembolism (VTE) than Group 1 (65% vs 13.6%, p = 0.001). One patient (4.5%) of Group 1 and three patients (15%) of Group 2 suffered from minor bleeding; no patient had major bleeding. Group 2 had a longer ICU and hospital stay than Group 1 (11.5 ± 5.6 vs 9.0 ± 4.8 and 30 ± 4.9 vs 21 ± 2.3, p < 0.05, respectively) as well as increased ICU mortality (25% vs 9.1%).

Conclusions: More severe critically ill COVID-19 patients have a high incidence of VTE and worse outcome, despite the use of heparin at the therapeutic dose. However, the use of heparin did not increase the incidence of bleeding complications.

Keywords: Anticoagulation; COVID-19; D-dimer; Pneumonia; Thrombosis.

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Conflict of interest statement

No conflict to declare.

References

    1. Xion T.Y., Redwood S., Prendergast B. Coronaviruses and the cardiovascular system: acute and long-term implications. Eur. Heart J. 2020;41(19):1798–1800. doi: 10.1093/eurheartj/ehaa231. - DOI - PMC - PubMed
    1. Lin L., Lu L., Cao W., Li T. Hypothesis for potential pathogenesis of SARS-CoV-2 infection: a review of immune changes in patients with viral pneumonia. Emerg. Microbes Infect. 2020;9(1):727–732. - PMC - PubMed
    1. Klok F.A., Kruip M.J.H.A., van der Meer N.J.M. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb. Res. 2020;191:145–147. - PMC - PubMed
    1. Demelo-Rodriguez P., Cervilla-Munoz E., Ordieres-Ortega L. Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels. Thromb. Res. 2020;192:23–26. - PMC - PubMed
    1. van Dam L.F., Kroft L.J.M., van der Wal L.I. Clinical and computed tomography characteristics of COVID-19 associated acute pulmonary embolism: a different phenotype of thrombotic disease? Thromb. Res. 2020;193:86–89. - PMC - PubMed

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