Evaluation of intensified low molecular weight heparin or unfractionated heparin for venous thromboembolism prophylaxis in critically ill patients with COVID-19

ABSTRACT

Introduction: Initiation of prophylactic anticoagulation is standard of care for severely ill patients, including coronavirus disease 19 (COVID-19) patients who may be hypercoagulable. Determining an optimal prophylactic regimen is crucial to limit the number of inhospital venous thromboembolism (VTE) and bleeding events. Research Question or Hypothesis: What is the proportion of COVID- 19 patients on a COVID-19 intensive care unit (ICU) VTE prophylaxis protocol who develop in-hospital VTE or bleeding events? Study Design: Retrospective cohort study Methods: Hospitalized, COVID-19 positive adult patients who were initiated on intensified and renally-adjusted heparin or enoxaparin VTE prophylaxis were included. The primary endpoint was to determine the proportion of patients on COVID-19 ICU VTE prophylaxis who had an in-hospital VTE event, and secondary endpoints assessed international society of thrombosis and hemostasis bleeding events, other ischemic outcomes including myocardial infarction and stroke, and 30-day readmissions for VTE. Institutional review board approval was obtained. Results: This study included 41 patients who were approximately 57 years old and 65.9% female. This population included 3 patients with a history of VTE and 2 with a history of cancer. The median ICU length of stay was 6 days. No patient experienced an in-hospital VTE event. The median Improve Bleed Score was a 6, and bleeding events occurred in 5 patients (12.2%) with 3 defined as major bleeds and 2 as minor bleeds. An ischemic event (ST-elevation myocardial infarction) occurred in one patient (2.4%) and readmission to a Kaleida Health facility within 30 days of discharge for a new VTE event occurred in 1 patient (2.4%). Conclusion: In patients with COVID-19 who received the Kaleida COVID-19 ICU VTE prophylaxis protocol, no in-hospital VTE events occurred, but 12.2% experienced a bleeding event. Use of this protocol in an expanded population may decrease VTE events, with a potential to increase bleeding rates.