The Impact of Risk-Adjusted Heparin Regimens on the Outcome of Patients with COVID-19 Infection. A Prospective Cohort Study

被引:9
|
作者
Di Micco, Pierpaolo [1 ]
Tufano, Antonella [2 ]
Cardillo, Giuseppe [3 ]
Imbalzano, Egidio [4 ]
Amitrano, Maria [5 ]
Lodigiani, Corrado [6 ]
Bellizzi, Annamaria [7 ]
Camporese, Giuseppe [8 ]
Cavalli, Antonella [7 ]
De Stefano, Carmela [5 ]
Russo, Vincenzo [9 ]
Voza, Antonio [6 ]
Perrella, Alessandro [10 ]
Prandoni, Paolo [11 ]
机构
[1] Osped Buon Consiglio Fatebenefratelli Napoli, Dept Med, I-80122 Naples, Italy
[2] Federico II Univ Naples, Dept Clin Med & Surg, I-80131 Naples, Italy
[3] Medylab, Clin Chem, I-81030 Lusciano, Italy
[4] Univ Messina, Dept Clin & Expt Med, I-98124 Messina, Italy
[5] AO Moscati, Dept Med, I-83100 Avellino, Italy
[6] IRCCS, Humanitas Clin & Res Ctr, I-20089 Rozzano, Italy
[7] Frangipane Hosp, Unit Internal Med, I-83031 Ariano Irpino, Italy
[8] Univ Padua, Dept Cardiac Thorac & Vasc Sci, Unit Angiol, I-35100 Padua, Italy
[9] Univ Campania Luigi Vanvitelli, Dept Translat Med Sci, Chair Cardiol, I-80131 Naples, Italy
[10] AO Cardarelli, I-80131 Naples, Italy
[11] Arianna Fdn Anticoagulat, I-40138 Bologna, Italy
来源
VIRUSES-BASEL | 2021年 / 13卷 / 09期
关键词
venous thromboembolism (VTE); SAR-CoV-2; pulmonary embolism; COVID-19; VENOUS THROMBOEMBOLISM; AMERICAN SOCIETY; GUIDELINES;
D O I
10.3390/v13091720
中图分类号
Q93 [微生物学];
学科分类号
071005 ; 100705 ;
摘要
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.
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页数:6
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