Thromboprophylaxis in COVID‐19: Weight and severity adjusted intensified dosing
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‐...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-03-01
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| Series: | Research and Practice in Thrombosis and Haemostasis |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/rth2.12683 |
| _version_ | 1797703301338234880 |
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| 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 |
| author_facet | 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 |
| author_sort | Matthias M. Engelen |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-12T05:03:29Z |
| format | Article |
| id | doaj.art-2c1238428a3c4e769f7bde88fe726124 |
| institution | Directory Open Access Journal |
| issn | 2475-0379 |
| language | English |
| last_indexed | 2024-03-12T05:03:29Z |
| publishDate | 2022-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Research and Practice in Thrombosis and Haemostasis |
| spelling | doaj.art-2c1238428a3c4e769f7bde88fe7261242023-09-03T09:03:30ZengElsevierResearch and Practice in Thrombosis and Haemostasis2475-03792022-03-0163n/an/a10.1002/rth2.12683Thromboprophylaxis in COVID‐19: Weight and severity adjusted intensified dosingMatthias M. Engelen0Christophe Vandenbriele1Valérie Spalart2Caroline P. Martens3Bert Vandenberk4Pieter Sinonquel5Natalie Lorent6Paul De Munter7Rik Willems8Joost Wauters9Alexander Wilmer10Dieter Dauwe11Jan Gunst12Ipek Guler13Stefan Janssens14Kimberly Martinod15Griet Pieters16Kathelijne Peerlinck17Peter Verhamme18Thomas Vanassche19Department of Cardiovascular Diseases University Hospitals Leuven Leuven BelgiumDepartment of Cardiovascular Diseases University Hospitals Leuven Leuven BelgiumDepartment of Cardiovascular Diseases University Hospitals Leuven Leuven BelgiumCenter for Molecular and Vascular Biology Department of Cardiovascular Sciences KU Leuven Leuven BelgiumDepartment of Cardiovascular Diseases University Hospitals Leuven Leuven BelgiumDepartment of Gastro‐enterology and Hepatology University Hospitals Leuven Leuven BelgiumDepartment of Respiratory Diseases University Hospitals Leuven Leuven BelgiumDepartment of General Internal Medicine University Hospitals Leuven Leuven BelgiumDepartment of Cardiovascular Diseases University Hospitals Leuven Leuven BelgiumMedical Intensive Care Unit Department of General Internal Medicine University Hospitals Leuven Leuven BelgiumMedical Intensive Care Unit Department of General Internal Medicine University Hospitals Leuven Leuven BelgiumDepartment of Intensive Care Medicine University Hospitals Leuven Leuven BelgiumDepartment of Intensive Care Medicine University Hospitals Leuven Leuven BelgiumLeuven Biostatistics and Statistical Bioinformatics Centre (L‐BioStat) KU Leuven Leuven BelgiumDepartment of Cardiovascular Diseases University Hospitals Leuven Leuven BelgiumCenter for Molecular and Vascular Biology Department of Cardiovascular Sciences KU Leuven Leuven BelgiumDepartment of Cardiovascular Diseases University Hospitals Leuven Leuven BelgiumDepartment of Cardiovascular Diseases University Hospitals Leuven Leuven BelgiumDepartment of Cardiovascular Diseases University Hospitals Leuven Leuven BelgiumDepartment of Cardiovascular Diseases University Hospitals Leuven Leuven BelgiumAbstract 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.https://doi.org/10.1002/rth2.12683anticoagulantsCOVID‐19hemorrhageheparinlow‐molecular‐weightthrombosis |
| spellingShingle | 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 Thromboprophylaxis in COVID‐19: Weight and severity adjusted intensified dosing Research and Practice in Thrombosis and Haemostasis anticoagulants COVID‐19 hemorrhage heparin low‐molecular‐weight thrombosis |
| title | Thromboprophylaxis in COVID‐19: Weight and severity adjusted intensified dosing |
| title_full | Thromboprophylaxis in COVID‐19: Weight and severity adjusted intensified dosing |
| title_fullStr | Thromboprophylaxis in COVID‐19: Weight and severity adjusted intensified dosing |
| title_full_unstemmed | Thromboprophylaxis in COVID‐19: Weight and severity adjusted intensified dosing |
| title_short | Thromboprophylaxis in COVID‐19: Weight and severity adjusted intensified dosing |
| title_sort | thromboprophylaxis in covid 19 weight and severity adjusted intensified dosing |
| topic | anticoagulants COVID‐19 hemorrhage heparin low‐molecular‐weight thrombosis |
| url | https://doi.org/10.1002/rth2.12683 |
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