Low-molecular-weight heparin for the prevention of clinical worsening in severe non-critically ill COVID-19 patients: a joint analysis of two randomized controlled trials

Wu, Maddalena Alessandra; Del GIovane, Cinzia; Colombo, Riccardo; Dolci, Giovanni; Arquati, Massimo; Vicini, Roberto; Russo, Umberto; Ruggiero, Diego; Coluccio, Valeria; Taino, Alba; Franceschini, Erica; Facchinetti, Pietro; Mighali, Pasquale; Trombetta, Lucia; Tonelli, Francesca; Gabiati, Claudia; Cogliati, Chiara; D’Amico, Roberto; Marietta, Marco; ,; Antinori, Spinello; Aschieri, Daniela; Brucato, Antonio; Brugioni, Lucio; Casalini, Giacomo; Clini, Enrico; Codeluppi, Mauro; Condorelli, Elena; Di Stasi, Silvia; Federici, Augusto B; Franco, Cosimo; Gemma, Marco; Gozzi, Annita; Ielpo, Antonella; Imberti, Davide; Magnacavallo, Andrea; Meschiari, Marianna; Mussini, Cristina; Nebuloni, Manuela; Picchi, Chiara; Pietrangelo, Antonello; Pinelli, Giovanni; Rizzardini, Giuliano; Santus, Pierachille; Sarti, Luca; Silva, Matteo; Vandelli, Paola; Wu, Maddalena Alessandra

doi:10.1007/s11739-023-03439-w

Cited by 2 publications

(1 citation statement)

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“…Proper risk stratification is imperative for selecting the most suitable anticoagulation regimen, considering the bleeding risks associated with anticoagulation [ 21 , 22 , 23 ]. The comprehensive management of VTE throughout the COVID-19 spectrum demands a nuanced approach, considering the multifactorial nature of the disease, the impact of SARS-CoV-2 infection, and the need for a dynamic evaluation of the balance between thrombotic and bleeding risk factors as patients recover from COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Venous Thromboembolism Management throughout the COVID-19 Era: Addressing Acute and Long-Term Challenges

Wu,

Taino,

Facchinetti

et al. 2024

JCM

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Background: COVID-19 increases the risk of venous thromboembolism (VTE) through a complex interplay of mechanisms collectively referred to as immunothrombosis. Limited data exist on VTE challenges in the acute setting throughout a dynamic long-term follow-up of COVID-19 patients compared to non-COVID-19 patients. The aim of the study was to investigate acute and long-term management and complications in VTE patients with and without COVID-19. Methods: A prospective, observational, single-center cohort study on VTE patients followed from the acute care stage until 24 months post-diagnosis. Results: 157 patients, 30 with COVID-19-associated VTE and 127 unrelated to COVID-19, were enrolled. The mean follow-up was 10.8 (±8.9) months. COVID-19 patients had fewer comorbidities (1.3 ± 1.29 vs. 2.26 ± 1.68, p < 0.001), a higher proportion of pulmonary embolism at baseline (96.7% vs. 76.4%, p = 0.01), and had a lower probability of remaining on anticoagulant therapy after three months (p < 0.003). The most used initial therapy was low-molecular-weight heparin in 130/157 cases, followed by long-term treatment with direct oral anticoagulants in 123/157. Two (6.7%) COVID-19 vs. three (2.4%) non-COVID-19 patients (p = 0.243) had major hemorrhagic events, all of them within the first three months. Four (3.1%) non-COVID-19 patients had VTE recurrence after six months. Three (2.4%) non-COVID-19 patients developed chronic thromboembolic pulmonary hypertension. There were no fatalities among patients with COVID-19, compared to a mortality of 12/127 (9.4%) in the non-COVID-19 subgroup (p = 0.027). Discussion: Our study offers a comprehensive overview of the evolving nature of VTE management, emphasizing the importance of personalized risk-based approaches, including a limited course of anticoagulation for most COVID-19-associated VTE cases and reduced-dose extended therapy for high-risk subsets.

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Section: Introductionmentioning

confidence: 99%