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J Thromb Thrombolysis
. 2020 Aug 13.
doi: 10.1007/s11239-020-02243-z. Online ahead of print.
Safety of intermediate dose of low molecular weight heparin in COVID-19 patients
Massimo Mattioli 1 , Devis Benfaremo 2 , Mauro Mancini 3 , Luciano Mucci 4 , Paola Mainqu? 5 , Antonio Polenta 6 , Patrizia Maria Baldini 4 , Francesca Fulgenzi 7 , Donatella Dennetta 8 , Samuele Bedetta 4 , Lorenzo Gasperoni 3 , Alessandro Caraffa 3 , Gabriele Frausini 4
Affiliations
- PMID: 32794132
- DOI: 10.1007/s11239-020-02243-z
Abstract
Coagulopathy represents one of the most important determinants of morbidity and mortality in coronavirus disease-19 (COVID-19). Whether standard thromboprophylaxis is sufficient or higher doses are needed, especially in severe patients, is unknown. To evaluate the safety of intermediate dose regimens of low-weight molecular heparin (LWMH) in COVID-19 patients with pneumonia, particularly in older patients. We retrospectively evaluated 105 hospitalized patients (61 M, 44 F; mean age 73.7 years) treated with subcutaneous enoxaparin: 80 mg/day in normal weight and mild-to-moderate impair or normal renal function; 40 mg/day in severe chronic renal failure or low bodyweight (< 45 kg); 100 mg/day if bodyweight was higher than 100 kg. All the patients had radiologically confirmed pneumonia and 63.8% had severe COVID-19. None of the patients had fatal haemorrhage; two (1.9%) patients had a major bleeding event (one spontaneous hematoma and one gastrointestinal bleeding). Only 6.7% of patients needed transfusions of red blood cells. One thrombotic event (pulmonary embolism) was observed. When compared to younger patients, patients older than 85 years had a higher mortality (40% vs 13.3%), but not an increased risk of bleeding or need for blood transfusion. The use of an intermediate dose of LWMH appears to be feasible and data suggest safety in COVID-19 patients, although further studies are needed.
Keywords: Bleeding; COVID-19; Heparin; Pneumonia; Safety.