Enoxaparin Use in Hospitalized SARS-CoV-2-Positive Patients with Elevated D-Dimer: A Pilot Study

Abstract

Introduction The SARS-CoV-2 is a human pathogenic coronavirus that causes a respiratory tract infection, which may lead to systemic hyper-inflammation that is associated with a hypercoagulable state. Anticoagulation as an adjunct may decrease thrombi formation. Objectives This study aims to evaluate the efficacy and safety of enoxaparin for the prevention of thrombotic events in hospitalized SARS-CoV-2 patients with elevated D-dimer. Methods A single-center retrospective cohort study was conducted to evaluate three enoxaparin dosing regimens: full treatment (1 mg/kg SC Q12H or 1.5 mg/kg SC Q24H), intermediate (.5 mg/kg SC Q12H or 1 mg/kg SC Q24H), and prophylaxis (40 mg SC Q24H). The primary endpoint evaluated the percentage of patients who developed a venous thromboembolism (VTE). The secondary endpoints evaluated the development of a major bleed, mechanical ventilation need, and death. Results Forty-five patients were included with 27, 8, and 10 participants in the full treatment, intermediate, and prophylaxis arms, respectively. Six patients developed a VTE: 3, 1, and 2 in the listed above groups, respectively ( P = .83). Twenty patients died: 11, 3, and 6, respectively ( P = .64). Four patients developed a major bleed: 1, 1, and 2, respectively ( P = .17). Six patients required intubation: 1, 2, and 3 in the arms, respectively ( P = .043). Conclusion The study did not find a difference in respect to the development of a VTE between the three investigated doses of anticoagulation. However, our findings suggest that treatment dose of enoxaparin might be associated with lower risk for mechanical ventilation in hospitalized COVID-19-positive patients with elevated D-dimer.

Factor Xa inhibitors versus low molecular weight heparin for preventing coagulopathy following COVID-19: a systematic review and meta analysis of randomized controlled trials

“…Recently, LMWH, particularly enoxaparin, has demonstrated effective anticoagulation properties and has been endorsed for use in COVID-19 patients who are hospitalized 23 . Nevertheless, preliminary evidence indicates that individuals with COVID-19 have a significantly increased susceptibility to thrombosis, even when they are administered conventional or escalated dosages of thromboprophylaxis with LMWH or UFH.…”

The optimal anticoagulation strategy for COVID-19, prophylactic or therapeutic?: a meta-analysis, trial sequential analysis, and meta-regression of more than 27,000 participants

“…44 Longhitano et al [63] Cohort study Enoxaparin, 80 U/kg sc qd UFH, 5000 U sc q8h 45 Nadeem et al [64] Cohort study [65] Cohort study Single center Noncritical 39 20 Enoxaparin Enoxaparin 1 mg/kg bid 40 mg qd 47 Zalivansky et al [66] Cohort (version 3.6) software was used. Quality was downgraded based on the following evaluations: risk of bias, inconsistency, indirectness, imprecision, and other considerations.…”