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Increased Doses of Low-molecular-weight Heparin in Hospitalized Patients with Covid-19

1Fondazione IRCCS Ca' Granda - Ospedale Policlinico, A. Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy, 2Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy, 3University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy, 4Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Department of Medicine - Acute Medical Unit, Milan, Italy, 5Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Department of Anesthesia, Intensive Care and Emergency, Milan, Italy, 6Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Department of Internal Medicine, Infectious Diseases Unit, Milan, Italy, 7Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Radiology Unit, Milan, Italy

Abstract Number: PB/CO15

Meeting: ISTH 2020 Congress

Theme: Venous Thromboembolism and Cardioembolism » VTE Prophylaxis

Background: Standard prophylactic doses of low-molecular-weight heparin may be insufficient to prevent venous thromboembolism in patients with Covid-19.

Aims: To investigate whether high doses of enoxaparin are associated with better clinical outcomes than standard prophylactic doses among hospitalized patients with Covid-19.

Methods: We conducted an observational cohort study in adult patients consecutively admitted to our hospital from March 9 to April 7, 2020 for the respiratory illness Covid-19. The high rate of venous thromboembolism prompted us to increase the prophylactic doses of enoxaparin from 40 mg daily to 1 mg/kg twice daily in patients admitted to intensive care units (ICU), 0.7 mg/kg twice daily in high-intensity of care wards and 1 mg/kg daily in low-intensity of care wards. Patients on high enoxaparin doses were compared to those who received prophylaxis with standard dosage. The primary endpoint was mortality and clinical deterioration. Other endpoints were the occurrence of venous thromboembolism and bleeding.

Results: Of 278 patients with Covid-19, 127 received high enoxaparin doses and 151 standard doses prophylaxis. At 21 days, the incidence rate of death and clinical deterioration were lower in patients on high doses than in those on the standard dosage prophylaxis (hazard ratio 0.38, 95% confidence interval 0.23-0.62) (Figure 1), and the incidence of venous thromboembolism was also lower (hazard ratio 0.30, 95% confidence interval 0.14-0.65) (Figure 2). Major bleeding occurred in 4 of 127 patients (3.1%) on the high enoxaparin doses.

Conclusions: In patients with Covid-19, high enoxaparin dosages resulted in a 60% reduction of mortality and clinical deterioration and a 70% reduction of venous thromboembolism compared to standard dosage prophylaxis. However, 3% of patients on high enoxaparin dosages had non-fatal major bleeding.


[Figure 1]


[Figure 2]

To cite this abstract in AMA style:

Martinelli I, Ciavarella A, Abbattista M, Aliberti S, De Zan V, Folli C, Panigada M, Gori A, Artoni A, Ierardi AM, Carrafiello G, Monzani V, Grasselli G, Blasi F, Peyvandi F. Increased Doses of Low-molecular-weight Heparin in Hospitalized Patients with Covid-19 [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/increased-doses-of-low-molecular-weight-heparin-in-hospitalized-patients-with-covid-19/. Accessed January 21, 2022.

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