Venous thromboembolism and bleeding in critically ill COVID-19 patients treated with higher than standard low molecular weight heparin doses and aspirin: A call to action

Abstract

Background Critically ill COVID-19 patients have a clear pattern of inflammation and hypercoagulable state. The main aim of the study was to evaluate the outcome of severe COVID-19 patients basing on prothrombotic risk factors (i.e. D-dimer). We also evaluated the impact of different doses of low molecular weight heparin (LMWH) on the incidence of bleedings. Methods The data of forty-two patients admitted to the Intensive Care Unit (ICU) were retrospectively analyzed. On ICU admission, patients with D-dimer < 3000 ng/mL (Group 1) received enoxaparin 4000 UI (6000 UI, if body mass index >35) subcutaneously b.i.d. and patients with D-dimer ≥ 3000 ng/mL (Group 2) received enoxaparin 100 UI/kg every 12 h. Aspirin was administered to all patients once a day. Results Both groups presented a high incidence of perivascular thrombosis (40.9% in Group 1 and 30% in Group 2). Patients of Group 2 suffered a higher incidence of venous thromboembolism (VTE) than Group 1 (65% vs 13.6%, p = 0.001). One patient (4.5%) of Group 1 and three patients (15%) of Group 2 suffered from minor bleeding; no patient had major bleeding. Group 2 had a longer ICU and hospital stay than Group 1 (11.5 ± 5.6 vs 9.0 ± 4.8 and 30 ± 4.9 vs 21 ± 2.3, p < 0.05, respectively) as well as increased ICU mortality (25% vs 9.1%). Conclusions More severe critically ill COVID-19 patients have a high incidence of VTE and worse outcome, despite the use of heparin at the therapeutic dose. However, the use of heparin did not increase the incidence of bleeding complications.

Common drugs, vitamins, nutritional supplements and COVID‑19 mortality

“…Coagulopathy and blood clots are a significant adverse event in patients with COVID-19. Aspirin inhibits the coagulation due to its effect on platelets and has been reported to improve patient prognosis (3)(4)(5). The present study was not able to confirm this observation as the patients on aspirin in the current sample were significantly older and therefore less likely to survive.…”

Potential Interaction Between SARS-CoV-2 and Thyroid: A Review

“…Hence, early anticoagulation such as heparin may reduce coagulopathy, microthrombus formation, and the risk of organ damage. The role of heparin in COVID-19 is supported by several retrospective studies ( 84-86 ), but its exact curative effect and appropriate effective dose should be proven in high-quality clinical trials.…”

Therapeutic strategies to fight COVID-19: which is the status artis?

“…A recent retrospective observational study, evaluating the impact of different doses of LMWH on the incidence of bleedings in COVID-19 patients admitted to ICUs, showed that the use of therapeutic doses of heparin did not increase the risk of bleeding in their patient population. Moreover, the study suggested the importance of applying a risk stratification based on D-dimer values for critically ill patients with COVID-19 (Pavoni et al, 2020). Based on these considerations, a close clinical monitoring and an individual patient evaluation for the risk of thrombosis and bleedings should be applied (Gozzo et al, 2020).…”