Venous thromboembolism and bleeding in critically ill COVID-19 patients treated with higher than standard low molecular weight heparin doses and aspirin: A call to action.
Thromb Res
; 196: 313-317, 2020 12.
Article
in English
| MEDLINE | ID: covidwho-752817
ABSTRACT
BACKGROUND:
Critically ill COVID-19 patients have a clear pattern of inflammation and hypercoagulable state. The main aim of the study was to evaluate the outcome of severe COVID-19 patients basing on prothrombotic risk factors (i.e. D-dimer). We also evaluated the impact of different doses of low molecular weight heparin (LMWH) on the incidence of bleedings.METHODS:
The data of forty-two patients admitted to the Intensive Care Unit (ICU) were retrospectively analyzed. On ICU admission, patients with D-dimerâ¯<â¯3000â¯ng/mL (Group 1) received enoxaparin 4000 UI (6000 UI, if body mass index >35) subcutaneously b.i.d. and patients with D-dimerâ¯≥â¯3000â¯ng/mL (Group 2) received enoxaparin 100â¯UI/kg every 12â¯h. Aspirin was administered to all patients once a day.RESULTS:
Both groups presented a high incidence of perivascular thrombosis (40.9% in Group 1 and 30% in Group 2). Patients of Group 2 suffered a higher incidence of venous thromboembolism (VTE) than Group 1 (65% vs 13.6%, pâ¯=â¯0.001). One patient (4.5%) of Group 1 and three patients (15%) of Group 2 suffered from minor bleeding; no patient had major bleeding. Group 2 had a longer ICU and hospital stay than Group 1 (11.5⯱â¯5.6 vs 9.0⯱â¯4.8 and 30⯱â¯4.9 vs 21⯱â¯2.3, pâ¯<â¯0.05, respectively) as well as increased ICU mortality (25% vs 9.1%).CONCLUSIONS:
More severe critically ill COVID-19 patients have a high incidence of VTE and worse outcome, despite the use of heparin at the therapeutic dose. However, the use of heparin did not increase the incidence of bleeding complications.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Aspirin
/
Heparin, Low-Molecular-Weight
/
Venous Thromboembolism
/
SARS-CoV-2
/
COVID-19
/
Hemorrhage
/
Anticoagulants
Type of study:
Experimental Studies
/
Observational study
/
Prognostic study
/
Randomized controlled trials
Topics:
Long Covid
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
English
Journal:
Thromb Res
Year:
2020
Document Type:
Article
Affiliation country:
J.thromres.2020.09.013
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