Background: Covid-19 infection is associated with a widespread global activation of coagulation and affected patients are at an increased risk of thrombosis.

Aims: Heparin therapy is effective in various setting in preventing thromboembolic complications and aim of this study was to assess heparin response in COVID-19 patients through anti-FXa test.

Methods: In 52 patients, M:F ratio 59:41, median age 59 years old, admitted in different intensity of care units of our hospital, treated with different regimens of heparin (100 U/kg every 24 hours in low intensity care, 70U/kg every 12 hours in intermediate intensity care and 100 U/kg every 12 hours in intensive care unit), anti-FXa levels were measured immediately before and 3 hours after subcutaneous enoxaparin administration.  On the same samples thrombin generation tests were performed.

Results: Patients treated with 100U/kg every 24 hours and 70 U/kg every 12 hours had median anti-FXa basal levels in the prophylactic range, respectively 0.18 and 0.22 U/ml, while patients treated with 100U/kg every 12 hours were in the anticoagulant range (0.37 U/ml). Despite heparin therapy thrombin generation was elevated in COVID-19 patients, indicating a high level of coagulation activation.

Conclusions: In conclusion we demonstrated that the biological response to enoxaparin in COVID-19 patients is in the expected range using anti-FXa assay and patients are not resistant to heparin therapy.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/anticoagulant-response-to-tailored-low-molecular-weight-heparin-regimens-in-patients-with-covid-19-infection/