Abstract Number: PB0180
Meeting: ISTH 2021 Congress
Theme: COVID and Coagulation » COVID and Coagulation, Clinical
Background: COVID-19 is frequently associated with venous thromboembolism (VTE), and the use of thromboprophylaxis has been suggested to improve hospitalized patients’ outcomes. We, therefore, intensified our thromboprophylactic protocol starting March 31st.
Aims: We aimed to validate the implementation of an intensified thromboprophylactic protocol by reporting VTE incidence and safety while awaiting randomized controlled trials.
Methods: On March 31st, 2020, we implemented an intensified thromboprophylactic protocol based on weight and disease severity (50 IU anti-Xa LMWH/kg, once daily at the ward, twice daily at the intensive care unit (ICU)). ICU patients were monitored daily with anti-Xa serum levels. Full therapeutic doses were restricted to patients with a prior indication for therapeutic anticoagulation or confirmed VTE. As early reports demonstrated high VTE incidence, screening with duplex ultrasound became standard of care in our center as soon as logistically possible. We excluded patients with a prior indication for therapeutic anticoagulation and incidental findings of COVID-19 for analysis. The ethical committee has approved this observational study.
Results: We analyzed 412 symptomatic and confirmed Covid-19 cases, of which 116 were admitted to the ICU. All symptomatic VTE cases were reported, and 20% of all patients (38% of ICU patients) received screening with venous ultrasound. In 219 patients who received the standard dose of LMWH, 16 patients (7.3%) had VTE, 10 of which were symptomatic (4.6%) (Figure 1). In 193 patients who received intensified thromboprophylaxis, there were no symptomatic VTE cases, three incidental DVT cases (1.6%), and one incidental pulmonary embolism (0.5%). Interestingly, rates of major bleeding were low (Figure 2).
Conclusions: In a large cohort of hospitalized patients with COVID-19, we report no symptomatic VTE after implementing systematic thromboprophylaxis with weight-adjusted prophylactic (ward) to intermediate (ICU), but not therapeutic doses of LMWH. This strategy was associated with a low risk of major bleeding.
To cite this abstract in AMA style:
M Engelen M, P Martens C, Spalart V, Peerlinck K, Willems R, Vandenberk B, De Munter P, Lorent N, Guler I, Pieters G, Sinonquel P, Vermeulen J, Martinod K, Verhamme P, Vandenbriele C, Vanassche T. Weight Adjusted Prophylactic to Intermediate Dosed Thromboprophylaxis in COVID-19 [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/weight-adjusted-prophylactic-to-intermediate-dosed-thromboprophylaxis-in-covid-19/. Accessed March 22, 2024.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/weight-adjusted-prophylactic-to-intermediate-dosed-thromboprophylaxis-in-covid-19/