The Impact of Risk-Adjusted Heparin Regimens on the Outcome of Patients with COVID-19 Infection. A Prospective Cohort Study
Background. According to recent guidelines, all hospitalized patients with COVID-19 should receive pharmacological prophylaxis for venous thromboembolism (VTE), unless there are specific contraindications. However, the optimal preventive strategy in terms of intensity of anticoagulation for these pa...
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MDPI AG
2021-08-01
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| Online Access: | https://www.mdpi.com/1999-4915/13/9/1720 |
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| author | Pierpaolo Di Micco Antonella Tufano Giuseppe Cardillo Egidio Imbalzano Maria Amitrano Corrado Lodigiani Annamaria Bellizzi Giuseppe Camporese Antonella Cavalli Carmela De Stefano Vincenzo Russo Antonio Voza Alessandro Perrella Paolo Prandoni |
| author_facet | Pierpaolo Di Micco Antonella Tufano Giuseppe Cardillo Egidio Imbalzano Maria Amitrano Corrado Lodigiani Annamaria Bellizzi Giuseppe Camporese Antonella Cavalli Carmela De Stefano Vincenzo Russo Antonio Voza Alessandro Perrella Paolo Prandoni |
| author_sort | Pierpaolo Di Micco |
| collection | DOAJ |
| description | Background. According to recent guidelines, all hospitalized patients with COVID-19 should receive pharmacological prophylaxis for venous thromboembolism (VTE), unless there are specific contraindications. However, the optimal preventive strategy in terms of intensity of anticoagulation for these patients is not well established. Objectives. To investigate the impact of individualized regimens of enoxaparin on the development of VTE and on the risk of major bleeding complications during hospitalization in patients with COVID-19 infection. Methods. All consecutive patients admitted to the medical wards of six Italian hospitals between 15 September and 15 October 2020 with COVID-19 infection of moderate severity were administered enoxaparin in subcutaneous daily doses adjusted to the Padua Prediction Score stratification model: No heparin in patients scoring less than 4, 4000 IU daily in those scoring 4, 6000 IU in those scoring 5, and 8000 in those scoring six or more. Objective tests were performed in patients developing clinical symptoms of deep vein thrombosis and/or pulmonary embolism. Bleeding complications were defined according to the ISTH classification. Results. From the 154 eligible patients, enoxaparin was administered in all: 4000 IU in 73 patients, 6000 IU in 53, and 8000 IU in the remaining 28. During the course of hospitalization, 27 patients (17.5%) died. VTE developed in 14 of the 154 patients (9.1%; 95% CI, 4.6% to 13.6%), and was fatal in 1. Major bleeding complications developed in 35 patients (22.7%; 95% CI, 16.1% to 29.3%), and were fatal in 8. Conclusions. Despite the use of risk-adjusted doses of enoxaparin, the rate of VTE events was consistent with that reported in contemporary studies where fixed-dose low-molecular-weight heparin was used. The unexpectedly high risk of bleeding complications should induce caution in administering enoxaparin in doses higher than the conventional low ones. |
| first_indexed | 2024-03-10T07:09:07Z |
| format | Article |
| id | doaj.art-e02df5e37d1d447e9710b548dd919c09 |
| institution | Directory Open Access Journal |
| issn | 1999-4915 |
| language | English |
| last_indexed | 2024-03-10T07:09:07Z |
| publishDate | 2021-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Viruses |
| spelling | doaj.art-e02df5e37d1d447e9710b548dd919c092023-11-22T15:36:58ZengMDPI AGViruses1999-49152021-08-01139172010.3390/v13091720The Impact of Risk-Adjusted Heparin Regimens on the Outcome of Patients with COVID-19 Infection. A Prospective Cohort StudyPierpaolo Di Micco0Antonella Tufano1Giuseppe Cardillo2Egidio Imbalzano3Maria Amitrano4Corrado Lodigiani5Annamaria Bellizzi6Giuseppe Camporese7Antonella Cavalli8Carmela De Stefano9Vincenzo Russo10Antonio Voza11Alessandro Perrella12Paolo Prandoni13Department of Medicine, Ospedale Buon Consiglio Fatebenefratelli di Napoli, 80122 Naples, ItalyDepartment of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, ItalyMedylab, Clinical Chemistry, 81030 Lusciano, ItalyDepartment of Clinical and Experimental Medicine, University of Messina, 98124 Messina, ItalyDepartment of Medicine, AO Moscati, 83100 Avellino, ItalyHumanitas Clinical and Research Center IRCCS, 20089 Rozzano, ItalyUnit of Internal Medicine, Frangipane Hospital, 83031 Ariano Irpino, ItalyUnit of Angiology, Department of Cardiac, Thoracic and Vascular Sciences, Padua University, 35100 Padua, ItalyUnit of Internal Medicine, Frangipane Hospital, 83031 Ariano Irpino, ItalyDepartment of Medicine, AO Moscati, 83100 Avellino, ItalyChair of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, ItalyHumanitas Clinical and Research Center IRCCS, 20089 Rozzano, ItalyAO Cardarelli, 80131 Naples, ItalyArianna Foundation on Anticoagulation, 40138 Bologna, ItalyBackground. According to recent guidelines, all hospitalized patients with COVID-19 should receive pharmacological prophylaxis for venous thromboembolism (VTE), unless there are specific contraindications. However, the optimal preventive strategy in terms of intensity of anticoagulation for these patients is not well established. Objectives. To investigate the impact of individualized regimens of enoxaparin on the development of VTE and on the risk of major bleeding complications during hospitalization in patients with COVID-19 infection. Methods. All consecutive patients admitted to the medical wards of six Italian hospitals between 15 September and 15 October 2020 with COVID-19 infection of moderate severity were administered enoxaparin in subcutaneous daily doses adjusted to the Padua Prediction Score stratification model: No heparin in patients scoring less than 4, 4000 IU daily in those scoring 4, 6000 IU in those scoring 5, and 8000 in those scoring six or more. Objective tests were performed in patients developing clinical symptoms of deep vein thrombosis and/or pulmonary embolism. Bleeding complications were defined according to the ISTH classification. Results. From the 154 eligible patients, enoxaparin was administered in all: 4000 IU in 73 patients, 6000 IU in 53, and 8000 IU in the remaining 28. During the course of hospitalization, 27 patients (17.5%) died. VTE developed in 14 of the 154 patients (9.1%; 95% CI, 4.6% to 13.6%), and was fatal in 1. Major bleeding complications developed in 35 patients (22.7%; 95% CI, 16.1% to 29.3%), and were fatal in 8. Conclusions. Despite the use of risk-adjusted doses of enoxaparin, the rate of VTE events was consistent with that reported in contemporary studies where fixed-dose low-molecular-weight heparin was used. The unexpectedly high risk of bleeding complications should induce caution in administering enoxaparin in doses higher than the conventional low ones.https://www.mdpi.com/1999-4915/13/9/1720venous thromboembolism (VTE)SAR-CoV-2pulmonary embolismCOVID-19 |
| spellingShingle | Pierpaolo Di Micco Antonella Tufano Giuseppe Cardillo Egidio Imbalzano Maria Amitrano Corrado Lodigiani Annamaria Bellizzi Giuseppe Camporese Antonella Cavalli Carmela De Stefano Vincenzo Russo Antonio Voza Alessandro Perrella Paolo Prandoni The Impact of Risk-Adjusted Heparin Regimens on the Outcome of Patients with COVID-19 Infection. A Prospective Cohort Study Viruses venous thromboembolism (VTE) SAR-CoV-2 pulmonary embolism COVID-19 |
| title | The Impact of Risk-Adjusted Heparin Regimens on the Outcome of Patients with COVID-19 Infection. A Prospective Cohort Study |
| title_full | The Impact of Risk-Adjusted Heparin Regimens on the Outcome of Patients with COVID-19 Infection. A Prospective Cohort Study |
| title_fullStr | The Impact of Risk-Adjusted Heparin Regimens on the Outcome of Patients with COVID-19 Infection. A Prospective Cohort Study |
| title_full_unstemmed | The Impact of Risk-Adjusted Heparin Regimens on the Outcome of Patients with COVID-19 Infection. A Prospective Cohort Study |
| title_short | The Impact of Risk-Adjusted Heparin Regimens on the Outcome of Patients with COVID-19 Infection. A Prospective Cohort Study |
| title_sort | impact of risk adjusted heparin regimens on the outcome of patients with covid 19 infection a prospective cohort study |
| topic | venous thromboembolism (VTE) SAR-CoV-2 pulmonary embolism COVID-19 |
| url | https://www.mdpi.com/1999-4915/13/9/1720 |
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