RESUMEN
Introduction: Pulmonary embolism (PE) is a major cause of intensive care unit (ICU) mortality and morbidity [1]. Optimal venous thromboembolism preventive strategy in COVID-19 patients remains a controversial issue. Therapeutic anticoagulation in the context of severe COVID-19 without a formal indication does not appear to offer a survival advantage and was associated with increased risk of major bleeding episodes. Locally, we adopted an enhanced anticoagulation (enoxaparin twice a day) pathway guided by anti-Xa levels. Method(s): This is a retrospective cross-sectional single-center study between March 2020 and March 2021. All patients admitted to the intensive care unit at University Hospital Southampton with diagnosis of COVID-19 confirmed via a reverse-transcriptase-polymerase-chain reaction (RT-PCR) test were included in this study. Result(s): There were 292 admissions included in the study with a mean age of 60 (+/- 15). 67.1% received enhanced anticoagulation titrated according to anti-Xa levels. The median day 7 trough and peak anti-Xa levels were 0.33 (IQR 0.18-0.41) and 0.54 (IQR 0.33-0.68) respectively. 62 patients had CTPA for clinical suspicion of pulmonary embolism and 11 were positive. The overall incidence of PE was 3.8%. The distribution of PE was mostly bilateral segmental or unilateral segmental. There were no lobar or main pulmonary artery pulmonary embolism. There were 9 major bleeding episodes in those received enhanced anticoagulation. Conclusion(s): For critically ill COVID-19 patients, anti-Xa guided enhanced anticoagulation protocol proved to be associated with lower than anticipated incidence of PE with minimal clot burden. Randomised controlled trials are required to explore this concept further.