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Intern Emerg Med ; 16(5): 1223-1229, 2021 08.
Article in English | MEDLINE | ID: covidwho-1002167


We conducted an observational cohort study in adult patients consecutively admitted for the respiratory illness Covid-19 to our hub hospital from March 9 to April 7, 2020. The high observed rate of venous thromboembolism prompted us to increase the prophylactic doses of enoxaparin from 40 mg daily up to 1 mg/kg twice daily in patients admitted to intensive care units (ICU), 0.7 mg/kg twice daily in high-intensity of care wards and 1 mg/kg daily in low-intensity of care wards. Patients on high enoxaparin doses were compared to those who received prophylaxis with the standard dosage. Efficacy endpoints were mortality, clinical deterioration, and the occurrence of venous thromboembolism, safety endpoint was the occurrence of major bleeding. Of 278 patients with Covid-19, 127 received prophylaxis with high enoxaparin doses and 151 with standard dosage. At 21 days, the incidence rate of death and clinical deterioration were lower in patients on higher doses than in those on the standard dosage (hazard ratio 0.39, 95% confidence interval 0.23-0.62), and the incidence of venous thromboembolism was also lower (hazard ratio 0.52, 95% confidence interval 0.26-1.05). Major bleeding occurred in four of 127 patients (3.1%) on the high enoxaparin dosage. In conclusion, in the cohort of patients with Covid-19 treated with high enoxaparin dosages we observed a 60% reduction of mortality and clinical deterioration and a 50% reduction of venous thromboembolism compared to standard dosage prophylaxis. However, 3% of patients on high enoxaparin dosages had non-fatal major bleeding.

COVID-19 Drug Treatment , Heparin, Low-Molecular-Weight/administration & dosage , Hospitalization/statistics & numerical data , Pre-Exposure Prophylaxis/classification , Aged , Body Mass Index , COVID-19/mortality , Cohort Studies , Enoxaparin/administration & dosage , Enoxaparin/classification , Female , Heparin, Low-Molecular-Weight/classification , Humans , Male , Middle Aged , Pre-Exposure Prophylaxis/methods , Pre-Exposure Prophylaxis/statistics & numerical data , Venous Thromboembolism/prevention & control
J Ultrasound ; 24(2): 165-173, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-718543


PURPOSE: Aim of the study is to evaluate the incidence of DVT in COVID-19 patients and its correlation with the severity of the disease and with clinical and laboratory findings. METHODS: 234 symptomatic patients with COVID-19, diagnosed according to the World Health Organization guidelines, were included in the study. The severity of the disease was classified as moderate, severe and critical. Doppler ultrasound (DUS) was performed in all patients. DUS findings, clinical, laboratory's and therapeutic variables were investigated by contingency tables, Pearson chi square test and by Student t test and Fisher's exact test. ROC curve analysis was applied to study significant continuous variables. RESULTS: Overall incidence of DVT was 10.7% (25/234): 1.6% (1/60) among moderate cases, 13.8% (24/174) in severely and critically ill patients. Prolonged bedrest and intensive care unit admission were significantly associated with the presence of DVT (19.7%). Fraction of inspired oxygen, P/F ratio, respiratory rate, heparin administration, D-dimer, IL-6, ferritin and CRP showed correlation with DVT. CONCLUSION: DUS may be considered a useful and valid tool for early identification of DVT. In less severely affected patients, DUS as screening of DVT might be unnecessary. High rate of DVT found in severe patients and its correlation with respiratory parameters and some significant laboratory findings suggests that these can be used as a screening tool for patients who should be getting DUS.

COVID-19/complications , Ultrasonography, Doppler, Duplex/methods , Venous Thrombosis/complications , Venous Thrombosis/diagnostic imaging , Adult , Aged , C-Reactive Protein/metabolism , Critical Illness , Early Diagnosis , Ferritins/blood , Fibrin Fibrinogen Degradation Products/metabolism , Heparin/administration & dosage , Heparin/blood , Humans , Incidence , Intensive Care Units , Interleukin-6/blood , Male , Middle Aged , Oxygen/metabolism , Respiratory Rate , Risk Assessment , SARS-CoV-2 , Severity of Illness Index , Venous Thrombosis/blood