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. 2024 Nov 11:13:887.
doi: 10.12688/f1000research.146710.3. eCollection 2024.

A Dynamic, D-dimer-based Thromboprophylaxis Strategy in Patients with COVID-19

Lantarima Bhoopat  1   2 , Anastasia Martynova  1 , April Choi  3 , Pattharawin Pattharanitima  2 , Semi Han  1 , Senxi Du  1 , Ibrahim Syed  1 , Catherine Chan  4 , Esther E Oh  4 , Zea Borok  1   5 , Janice Liebler  1 , Melissa Lee Wilson  6 , Pichaya Tantiyavarong  2 , Casey O Connell  1
Affiliations

A Dynamic, D-dimer-based Thromboprophylaxis Strategy in Patients with COVID-19

Lantarima Bhoopat et al. F1000Res. .

Abstract

Background: COVID-19 pandemics increases venous thromboembolism (VTE) risk during hospitalization, despite prophylactic anticoagulation. Limited radiological diagnosis in pandemic requires a guided protocol for anticoagulant adjustment.

Methods: This retrospective cohort study was conducted at a single center as part of a quality improvement program evaluating the efficacy and safety of anticoagulation protocols. The study focused on implementing a guideline for anticoagulant dosing protocol based on dynamic changes in D-dimer levels in COVID-19 hospitalized patients. The dosing guideline allowed for dose escalation from standard prophylactic levels to escalated prophylactic or therapeutic levels, depending on the patient's risk profile for VTE. The primary endpoints included in-hospital survival comparing between fix and dynamic adjustment treatment groups. Secondary endpoints encompassed major and clinically relevant non-major bleeding (CRNMB) events, incidence of breakthrough thrombosis, length of hospitalization and ICU stay, days of mechanical ventilator use, and survival duration.

Findings: Among the 260 COVID-19-infected patients hospitalized between March 15th and June 15th, 2020. The patients received fixed anticoagulant dosage in 188, 72.3%) patients, while 72 (27.7%) were up-titrated according to the protocol. In-hospital survival at 30 days demonstrated superiority among patients whose anticoagulation was up-titrated to either escalated prophylactic or therapeutic (80.2%) compared to receiving fixed anticoagulant dosage (51.3%) (p=0.01). Bleeding events were significantly higher in up-titrate group (12.5%) compared to fixed anticoagulant dosage group (2.13%). Most of them are CRNMB.

Conclusion: A dynamic, D-dimer-based dose escalation of anticoagulation for hospitalized patients with COVID-19 holds promise in improving in-hospital mortality rates without a significant increase in fatal bleeding events.

Keywords: COVID-19; D-dimer; Thromboprophylaxis.

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Conflict of interest statement

Competing interests: Declaration of interests ☒ The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ☒The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Casey O’Connell: consulting fee from AbbVie Inc. Advisory Board Janice Liebler: Grants or contracts from Immunexpress, St. Michaels Hospital, Toronto, Canada, CDC Foundation No conflict of interest for other authors.

Figures

Figure 1.
Figure 1.. Anticoagulation Treatment Protocol Based on D-Dimer levels.
Figure 2.
Figure 2.. Kaplan-Meier estimates for in-hospital survival of COVID-infected patients comparing up-titrated anticoagulant group to those who received fixed anticoagulant dose since the beginning.
Figure 3.
Figure 3.. A. Mean profiles of D-dimer over hospitalization days. B. Mean profiles over time of D-dimer according to survival outcome and anticoagulant group. C. Mean profiles over time of D-dimer for each escalated step by random-intercept linear mixed model.
See this image and copyright information in PMC

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