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Res Pract Thromb Haemost
. 2021 May 7;5(4):e12521.
doi: 10.1002/rth2.12521. eCollection 2021 May.
Management of therapeutic unfractionated heparin in COVID-19 patients: A retrospective cohort study
Lachelle D Weeks 1 2 , Katelyn W Sylvester 3 , Jean M Connors 2 4 , Nathan T Connell 2 4
Affiliations
- PMID: 34013153
- PMCID: PMC8114028
- DOI: 10.1002/rth2.12521
Abstract
Background: Patients hospitalized with severe acute respiratory syndrome coronavirus 2 infection are at risk for thrombotic complications necessitating use of therapeutic unfractionated heparin (UFH). Full-dose anticoagulation limits requirements for organ support interventions in moderately ill patients with coronavirus disease 2019 (COVID-19). Given this benefit, it is important to evaluate response to therapeutic anticoagulation in this population.
Objectives: The aim of this study was to assess therapeutic UFH infusions and associated bleeding risk in patients with COVID-19.
Patients/methods: This retrospective cohort study includes patients at Brigham and Women's Hospital, Boston, Massachusetts, receiving weight-based nursing-nomogram titrated UFH infusion during a 10-week surge in COVID-19 hospitalizations. Of 358 patients on therapeutic UFH during this interval, 97 (27.1%) had confirmed COVID-19. Patient characteristics, laboratory values, and information regarding UFH infusion and bleeding events were obtained from the electronic medical record.
Results: Patients who were COVID-19 positive had fewer therapeutic activatrd partial thromboplastin times (aPTTs) compared to COVID-19-negative patients (median rate, 40.0% vs 53.1%; P < .0005). Both major and clinically relevant nonmajor bleeding were increased in COVID-19-positive patients, with major bleeding observed in 10.3% (95% confidence interval [CI], 5.7%-17.9%) of patients who were COVID-19 positive and 3.1% (95% CI, 1.6%-5.9%) of patients who were COVID-19 negative (P < .005). In logistic regression, bleeding events were associated with receiving UFH for longer than 7 days, but not platelet count, coagulation, or inflammatory measurements.
Conclusions: Our data indicate a higher incidence of bleeding complications in patients with COVID-19 receiving weight-based nursing-nomogram titrated UFH infusions despite a higher prevalence of subtherapeutic aPTTs in this population. These data underscore the need for prospective studies aimed at improving the quality and safety of therapeutic anticoagulation in patients with COVID-19.
Keywords: COVID?19; SARS?CoV?2; bleeding; coronavirus; coronavirus 2019; therapeutic anticoagulation; thromboembolism; thrombosis; unfractionated heparin.