Low molecular weight heparins in COVID-19 patients: beware of augmented renal clearance!

Tomasa-Irriguible, Teresa Maria; Martínez-Vega, S.; Mor-Marco, E.; Herraiz-Ruiz, Alba; Raguer-Pardo, Laura; Cubells-Larrosa, Carlos

doi:10.1186/s13054-020-03058-3

Cited by 21 publications

(31 citation statements)

References 6 publications

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“…A report in 47 ICU patients with COVID-19 identified 18 patients (38.3%) with augmented renal clearance. 87 Patients with augmented renal clearance had numerically more DVT (44% vs. 31%; p=0.352) and significantly more PE (33% vs. 10%; p=0.025) compared to those without, respectively. These data, although from a small group of patients, speaks…”

Section: Accepted Articlementioning

confidence: 89%

“…Augmented renal clearance is a process whereby renal clearance of medications is increased in the setting of critical illness. A report in 47 ICU patients with COVID‐19 identified 18 patients (38.3%) with augmented renal clearance 87 . Patients with augmented renal clearance had numerically more DVT (44% vs 31%; p=0.352) and significantly more PE (33% vs 10%; p=0.025) compared to those without, respectively.…”

Section: Prevention Of Vtementioning

confidence: 99%

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Coagulopathy, Venous Thromboembolism, and Anticoagulation in Patients with COVID‐19

Dobesh

Trujillo

2020

Pharmacotherapy

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)has led to a worldwide pandemic, and patients with the infection are referred to as having COVID-19. Although COVID-19 is commonly considered a respiratory disease, there is clearly a thrombotic potential that was not expected. The pathophysiology of the disease and subsequent coagulopathy produce an inflammatory, hypercoagulable, and hypofibrinolytic state. Several observational studies have demonstrated surprisingly high rates of venous thromboembolism (VTE) in both general ward and intensive care patients with COVID-19. Many of these observational studies demonstrate high rates of VTE despite patients being on standard, or even higher intensity, pharmacologic VTE prophylaxis. Fibrinolytic therapy has also been used in patients with acute respiratory distress syndrome. Unfortunately, high quality randomized controlled trials are lacking. A literature search was performed to provide the most up-to-date information on the pathophysiology, coagulopathy, risk of VTE, and prevention and treatment of VTE in patients with COVID-19. These topics are reviewed in detail, along with practical issues of anticoagulant selection and duration. Although a number of international organizations have produced guideline or consensus statements, they do not all cover the same issues regarding anticoagulant therapy for patients with COVID-19, and they do not all agree. These statements and the most recent literature are combined into a list of clinical considerations that clinicians can use for the prevention and treatment of VTE in patients with COVID-19.

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Section: Accepted Articlementioning

confidence: 89%

Section: Prevention Of Vtementioning

confidence: 99%

Coagulopathy, Venous Thromboembolism, and Anticoagulation in Patients with COVID‐19

Dobesh

Trujillo

2020

Pharmacotherapy

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“…106 In addition, due to augmented renal clearance, COVID-19 patients may have reduced anti-Xa activity despite standard dosages of LMWH. 107…”

Section: Methylprednisolone and Covid-19mentioning

confidence: 99%

RETRACTED: Clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19

Kory

Meduri

Iglesias

et al. 2020

J Intensive Care Med

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In December 2019, COVID-19, a severe respiratory illness caused by the new coronavirus SARS-CoV-2 (COVID-19) emerged in Wuhan, China. The greatest impact that COVID-19 had was on intensive care units (ICUs), given that approximately 20% of hospitalized cases developed acute respiratory failure (ARF) requiring ICU admission. Based on the assumption that COVID-19 represented a viral pneumonia and no anti-coronaviral therapy existed, nearly all national and international health care societies’ recommended “supportive care only” avoiding other therapies outside of randomized controlled trials, with a specific prohibition against the use of corticosteroids in treatment. However, early studies of COVID-19-associated ARF reported inexplicably high mortality rates, with frequent prolonged durations of mechanical ventilation (MV), even from centers expert in such supportive care strategies. These reports led the authors to form a clinical expert panel called the Front-Line COVID-19 Critical Care Alliance (www.flccc.net ). The panel collaboratively reviewed the emerging clinical, radiographic, and pathological reports of COVID-19 while initiating multiple discussions among a wide clinical network of front-line clinical ICU experts from initial outbreak areas in China, Italy, and New York. Based on the shared early impressions of “ what was working and what wasn’t working,” the increasing medical journal publications and the rapidly accumulating personal clinical experiences with COVID-19 patients, a treatment protocol was created for the hospitalized patients based on the core therapies of methylprednisolone, ascorbic acid, thiamine, heparin and co-interventions (MATH+). This manuscript reviews the scientific and clinical rationale behind MATH+ based on published in-vitro, pre-clinical, and clinical data in support of each medicine, with a special emphasis of studies supporting their use in the treatment of patients with viral syndromes and COVID-19 specifically. The review concludes with a comparison of published multi-national mortality data with MATH+ center outcomes.

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“…Therefore, ARC should be suspected and GFR ECC measured, especially in patients with plasma creatinine concentrations that decrease below their baseline value. This is of clinical relevance, as ARC may influence the pharmacokinetics of renally excreted drugs, potentially leading to suboptimal treatment [ 4 ]. The mechanisms leading to ARC are not yet fully elucidated.…”

mentioning

confidence: 99%

Late augmented renal clearance in patients with COVID-19 in the intensive care unit. A prospective observational study

Beunders

Wijgert

Berg

et al. 2021

Journal of Critical Care

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Low molecular weight heparins in COVID-19 patients: beware of augmented renal clearance!

Cited by 21 publications

References 6 publications

Coagulopathy, Venous Thromboembolism, and Anticoagulation in Patients with COVID‐19

Coagulopathy, Venous Thromboembolism, and Anticoagulation in Patients with COVID‐19

RETRACTED: Clinical and Scientific Rationale for the “MATH+” Hospital Treatment Protocol for COVID-19

Late augmented renal clearance in patients with COVID-19 in the intensive care unit. A prospective observational study

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