Heparin-Related Major Bleeding in Covid-19-Positive Patient: Perspective from the Outbreak

Thromboprophylaxis in COVID-19: Anti-FXa—the Missing Factor?

“…We reviewed anti-FXa activity in patients admitted to hospital with COVID-19 infection, all receiving pharmacological thromboprophylaxis with enoxaparin 40 mg once daily, creatinine clearance of >30 ml/min, and platelet count of >30 × 10 9 /L ( 7 ). We compared 4-hour after dose anti-FXa activity levels for 22 ward patients and 20 ITU patients ( Table 2 ).…”

“…The consideration of patient-specific risk factors for thrombosis and hemorrhage, together with the relationship between anti-FXa activity and clinical outcome, may be more important ( 9 ). This is of particular relevance in COVID-19, in which there is a recognized spectrum of thrombosis and bleeding risk in later stages of the infection ( 7 ). Furthermore, the growing autopsy histology literature demonstrates a heterogeneity of thrombotic disease manifestations, including mutually exclusive deep vein thrombosis and PE, often despite anticoagulant therapy ( 10 ).…”

Gastrointestinal Hemorrhages in Patients With COVID-19 Managed With Transarterial Embolization

“…Western European countries have experienced a rapid and impressive surge of novel coronavirus disease 2019 (COVID-19) cases. Although the principal cause of mortality is acute respiratory insufficiency, concern exists over the association between severe acute respiratory syndrome coronavirus 2 infection and coagulopathy that can precipitate disseminated intravascular coagulation ( 1 ). Local thrombi in the lungs and other organs are considered to be distinctive of severe COVID-19, which are responsible for the clinical manifestations of the disease related to ischemic damage ( 2 ).…”

Reply to Rappaport et al.: Anti-FXa Activity with Intermediate-Dose Thromboprophylaxis in COVID-19

“…As highlighted in our research correspondence, we agree that uncertainty remains about the value of anti-FXa monitoring in patients receiving thromboprophylaxis with low molecular heparin ( 2 ). Nevertheless, in the absence of clinical trial data confirming an optimal anticoagulation strategy for a condition with a recognized spectrum of thrombosis and clinically relevant bleeding ( 3 , 4 ), we suggest that the use of anti-FXa activity to inform dosing should not be completely dismissed.…”