tetano
Editor, Senior Moderator
Res Pract Thromb Haemost
. 2022 Apr 5;6(3):e12683.
doi: 10.1002/rth2.12683. eCollection 2022 Mar.
Thromboprophylaxis in COVID-19: Weight and severity adjusted intensified dosing
Matthias M Engelen[SUP] 1 2 [/SUP], Christophe Vandenbriele[SUP] 1 2 [/SUP], Valérie Spalart[SUP] 1 2 [/SUP], Caroline P Martens[SUP] 2 [/SUP], Bert Vandenberk[SUP] 1 [/SUP], Pieter Sinonquel[SUP] 3 4 [/SUP], Natalie Lorent[SUP] 5 [/SUP], Paul De Munter[SUP] 6 7 [/SUP], Rik Willems[SUP] 1 8 [/SUP], Joost Wauters[SUP] 9 [/SUP], Alexander Wilmer[SUP] 9 [/SUP], Dieter Dauwe[SUP] 10 [/SUP], Jan Gunst[SUP] 10 11 [/SUP], Ipek Guler[SUP] 12 [/SUP], Stefan Janssens[SUP] 1 [/SUP], Kimberly Martinod[SUP] 2 [/SUP], Griet Pieters[SUP] 1 [/SUP], Kathelijne Peerlinck[SUP] 1 2 [/SUP], Peter Verhamme[SUP] 1 2 [/SUP], Thomas Vanassche[SUP] 1 2 [/SUP]
Affiliations
Abstract
Background: Venous thromboembolism (VTE) frequently occurs in hospitalized patients with coronavirus disease 2019 (COVID-19). The optimal dose of anticoagulation for thromboprophylaxis in COVID-19 is unknown.
Aims: To report VTE incidence and bleeding before and after implementing a hospital-wide intensified thromboprophylactic protocol in patients with COVID-19.
Methods: On March 31, 2020, we implemented an intensified thromboprophylactic protocol consisting of 50 IU anti-Xa low molecular weight heparin (LMWH)/kg once daily at the ward, twice daily at the intensive care unit (ICU). We included all patients hospitalized in a tertiary care hospital with symptomatic COVID-19 between March 7 and July 1, 2020. The primary outcome was the incidence of symptomatic or subclinical VTE and major bleeding during admission. Routine ultrasound screening for VTE was performed whenever logistically possible.
Results: We included 412 patients, of which 116 were admitted to the ICU. Of 219 patients with standard a prophylactic dose of LMWH, 16 (7.3%) had VTE, 10 of which were symptomatic (4.6%). Of 193 patients with intensified thromboprophylaxis, there were no symptomatic VTE cases, three incidental deep venous thrombosis cases (1.6%), and one incidental pulmonary embolism (0.5%). The major bleeding rate was 1.2% in patients with intensified thromboprophylaxis and 7.7% when therapeutic anticoagulation was needed.
Conclusion: In hospitalized patients with COVID-19, there were no additional symptomatic VTEs and a reduction in incidental deep vein thrombosis after implementing systematic thromboprophylaxis with weight-adjusted prophylactic (ward) to intermediate (ICU), but not therapeutic dosed anticoagulation. This intensified thromboprophylaxis was associated with a lower risk of major bleeding compared with therapeutic dosed anticoagulation.
Keywords: COVID‐19; anticoagulants; hemorrhage; heparin; low‐molecular‐weight; thrombosis.
. 2022 Apr 5;6(3):e12683.
doi: 10.1002/rth2.12683. eCollection 2022 Mar.
Thromboprophylaxis in COVID-19: Weight and severity adjusted intensified dosing
Matthias M Engelen[SUP] 1 2 [/SUP], Christophe Vandenbriele[SUP] 1 2 [/SUP], Valérie Spalart[SUP] 1 2 [/SUP], Caroline P Martens[SUP] 2 [/SUP], Bert Vandenberk[SUP] 1 [/SUP], Pieter Sinonquel[SUP] 3 4 [/SUP], Natalie Lorent[SUP] 5 [/SUP], Paul De Munter[SUP] 6 7 [/SUP], Rik Willems[SUP] 1 8 [/SUP], Joost Wauters[SUP] 9 [/SUP], Alexander Wilmer[SUP] 9 [/SUP], Dieter Dauwe[SUP] 10 [/SUP], Jan Gunst[SUP] 10 11 [/SUP], Ipek Guler[SUP] 12 [/SUP], Stefan Janssens[SUP] 1 [/SUP], Kimberly Martinod[SUP] 2 [/SUP], Griet Pieters[SUP] 1 [/SUP], Kathelijne Peerlinck[SUP] 1 2 [/SUP], Peter Verhamme[SUP] 1 2 [/SUP], Thomas Vanassche[SUP] 1 2 [/SUP]
Affiliations
- PMID: 35415384
- PMCID: PMC8980774
- DOI: 10.1002/rth2.12683
Abstract
Background: Venous thromboembolism (VTE) frequently occurs in hospitalized patients with coronavirus disease 2019 (COVID-19). The optimal dose of anticoagulation for thromboprophylaxis in COVID-19 is unknown.
Aims: To report VTE incidence and bleeding before and after implementing a hospital-wide intensified thromboprophylactic protocol in patients with COVID-19.
Methods: On March 31, 2020, we implemented an intensified thromboprophylactic protocol consisting of 50 IU anti-Xa low molecular weight heparin (LMWH)/kg once daily at the ward, twice daily at the intensive care unit (ICU). We included all patients hospitalized in a tertiary care hospital with symptomatic COVID-19 between March 7 and July 1, 2020. The primary outcome was the incidence of symptomatic or subclinical VTE and major bleeding during admission. Routine ultrasound screening for VTE was performed whenever logistically possible.
Results: We included 412 patients, of which 116 were admitted to the ICU. Of 219 patients with standard a prophylactic dose of LMWH, 16 (7.3%) had VTE, 10 of which were symptomatic (4.6%). Of 193 patients with intensified thromboprophylaxis, there were no symptomatic VTE cases, three incidental deep venous thrombosis cases (1.6%), and one incidental pulmonary embolism (0.5%). The major bleeding rate was 1.2% in patients with intensified thromboprophylaxis and 7.7% when therapeutic anticoagulation was needed.
Conclusion: In hospitalized patients with COVID-19, there were no additional symptomatic VTEs and a reduction in incidental deep vein thrombosis after implementing systematic thromboprophylaxis with weight-adjusted prophylactic (ward) to intermediate (ICU), but not therapeutic dosed anticoagulation. This intensified thromboprophylaxis was associated with a lower risk of major bleeding compared with therapeutic dosed anticoagulation.
Keywords: COVID‐19; anticoagulants; hemorrhage; heparin; low‐molecular‐weight; thrombosis.