학술논문
Thromboprophylaxis in COVID‐19: Weight and severity adjusted intensified dosing
Document Type
article
Author
Matthias M. Engelen; Christophe Vandenbriele; Valérie Spalart; Caroline P. Martens; Bert Vandenberk; Pieter Sinonquel; Natalie Lorent; Paul De Munter; Rik Willems; Joost Wauters; Alexander Wilmer; Dieter Dauwe; Jan Gunst; Ipek Guler; Stefan Janssens; Kimberly Martinod; Griet Pieters; Kathelijne Peerlinck; Peter Verhamme; Thomas Vanassche
Source
Research and Practice in Thrombosis and Haemostasis, Vol 6, Iss 3, Pp n/a-n/a (2022)
Subject
Language
English
ISSN
2475-0379
Abstract
Abstract Background Venous thromboembolism (VTE) frequently occurs in hospitalized patients with coronavirus disease 2019 (COVID‐19). The optimal dose of anticoagulation for thromboprophylaxis in COVID‐19 is unknown. Aims To report VTE incidence and bleeding before and after implementing a hospital‐wide intensified thromboprophylactic protocol in patients with COVID‐19. Methods On March 31, 2020, we implemented an intensified thromboprophylactic protocol consisting of 50 IU anti‐Xa low molecular weight heparin (LMWH)/kg once daily at the ward, twice daily at the intensive care unit (ICU). We included all patients hospitalized in a tertiary care hospital with symptomatic COVID‐19 between March 7 and July 1, 2020. The primary outcome was the incidence of symptomatic or subclinical VTE and major bleeding during admission. Routine ultrasound screening for VTE was performed whenever logistically possible. Results We included 412 patients, of which 116 were admitted to the ICU. Of 219 patients with standard a prophylactic dose of LMWH, 16 (7.3%) had VTE, 10 of which were symptomatic (4.6%). Of 193 patients with intensified thromboprophylaxis, there were no symptomatic VTE cases, three incidental deep venous thrombosis cases (1.6%), and one incidental pulmonary embolism (0.5%). The major bleeding rate was 1.2% in patients with intensified thromboprophylaxis and 7.7% when therapeutic anticoagulation was needed. Conclusion In hospitalized patients with COVID‐19, there were no additional symptomatic VTEs and a reduction in incidental deep vein thrombosis after implementing systematic thromboprophylaxis with weight‐adjusted prophylactic (ward) to intermediate (ICU), but not therapeutic dosed anticoagulation. This intensified thromboprophylaxis was associated with a lower risk of major bleeding compared with therapeutic dosed anticoagulation.