Effectiveness of antithrombotic prophylaxis in hospitalised patients with SARS-CoV-2 infection

Abstract

Background Antithrombotic prophylaxis in hospitalised patients with SARS-CoV-2 acute infection has increased. Currently, most of the evidence relates to patients in intensive care units; however, there is little information on patients admitted to hospital wards and there is no consensus protocol on thromboprophylaxis during admission and after discharge. Objective To assess the effectiveness of antithrombotic prophylaxis in patients admitted with COVID-19 and 30 days after discharge. Method A prospective observational study was conducted of patients admitted with COVID-19 in which the hospital thromboprophylaxis protocol was applied, classifying the patients as having a standard or high risk of thrombosis. Pharmacists performed a daily follow-up and actively intervened during admission and at discharge. The main outcome measure was the global incidence of symptomatic venous thromboembolism (VTE) related to hospitalisation. Results A total of 113 patients were included, 98.23% of whom were admitted to a hospital ward. The incidence of hospital-acquired VTE was 1.77%. In 75.22% of the subjects, thromboprophylaxis was adjusted to the protocol during admission. A total of 23 pharmaceutical interventions were conducted, with an adherence of 52.17%. At discharge, 94.28% of the patients who had no haemorrhage and ≥4 points on the Padua Prediction Score required thromboprophylaxis, aligning with the protocol. The global incidence of haemorrhagic events during the follow-up period was 0.88%. Conclusion The incidence of hospital-acquired VTE was lower than that described in the literature. Although it cannot be certain that it is directly related to the instituted protocol, the data can show that the management of prevention of VTE is being optimally performed at the hospital. Long-term studies are needed to evaluate the incidence after discharge, as well as to agree on a specific protocol in the COVID-19 population for the prevention of these events during hospitalisation and post-discharge.

Incidence of lower limb deep vein thrombosis in patients with COVID-19 pneumonia through different waves of SARS-CoV-2 pandemic: A multicenter prospective study

“…Therefore, the modification of anticoagulation strategies during the pandemic could be a major determinant of the observed reduction of DVT incidence through different waves . The change in management reflects the evolving strategies of COVID-19 treatment over time, even not always supported by sound evidence [ 18 ]. In fact, the clinical benefits in initiating thromboprophylaxis early at home in patients with SARS-CoV-2 associated mild-to-moderate pneumonia has not been established, and current guidelines advice not starting anticoagulation for acutely ill COVID-19 outpatients with mild-to-moderate disease not requiring hospitalization, based mainly on the results of ACTIV-4b trial [ 24 – 27 ].…”

A systematic review on post-discharge venous thromboembolism prophylaxis in patients with COVID-19

“…Several cohort and guideline studies recommended LMWHs, especially enoxaparin. In this regard, Quiros Ambel et al provided a protocol in which patients in the absence of hemorrhagic risk and high risk of thrombosis should receive weight or albumin/creatinine ratio (ACR) adjusted LMWH (enoxaparin or bemiparine) for 4–6 weeks [ 27 ]. Patients weighted ≤ 50 kg or elderly patients with ACR < 30 ml/min should receive 2500 IU sc/day of bemiparine or 20mg sc/day of enoxaparin, patients weighted 51–80 kg should receive 40mg sc/day of enoxaparin or 3500IU sc/day of bemiparine.…”