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Thromboprophylaxis in Critically Ill Coronavirus Disease 2019 Patients
Michaël Piagnerelli1, Philippe Cauchie2, Maxime Vancutsem3
1Intensive Care, CHU-Charleroi Marie-Curie, Université Libre de Bruxelles, Charleroi, Belgium, and Experimental Medicine Laboratory, CHU-Charleroi, ULB 222 Unit, Université Libre de Bruxelles, Montigny-le-Tilleul, Belgium.
Insights
Critically ill patients with coronavirus disease 2019 (COVID-19) in the ICU experienced low anti-Xa levels despite adapted enoxaparin dosing. This suggests current thromboprophylaxis may be insufficient, necessitating further research.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Infectious Diseases
Background:
- Coronavirus disease 2019 (COVID-19) intensive care unit (ICU) patients face a heightened risk of thrombosis.
- Expert recommendations suggest higher doses of low-molecular-weight heparin (LMWH) for thromboprophylaxis, but robust data is limited.
Purpose of the Study:
- To evaluate an adapted LMWH thromboprophylaxis protocol in COVID-19 ICU patients.
- To assess anti-Xa activity levels and venous thromboembolism (VTE) incidence in this cohort.
Main Methods:
- Retrospective analysis of 106 anti-Xa measurements from 19 COVID-19 ICU patients.
- Administration of enoxaparin (60 mg once daily) with adjusted dosing based on body mass index.
- Monitoring of trough and peak anti-Xa activity levels.
Main Results:
- Despite adapted enoxaparin dosing, trough anti-Xa levels remained below optimal prophylactic ranges.
- Peak anti-Xa activity increased post-administration but stayed below target levels.
- Three out of 19 patients (16%) developed venous thromboembolism despite the adapted protocol.
Conclusions:
- Higher prophylactic enoxaparin doses, even when adapted for BMI, may not achieve adequate anti-Xa levels in critically ill COVID-19 patients.
- Current thromboprophylaxis strategies for COVID-19 ICU patients may be suboptimal.
- Urgent studies are needed to establish effective thromboprophylaxis regimens for this population.
Abstract:
It is now reported that coronavirus disease 2019 ICU patients are at increased risk of thrombosis. Expert opinion and scientific societies recommend a higher dose of low-molecular-weight heparin, but definitive data is lacking. We report our adapted thromboprophylaxis practice of low-molecular-weight heparin administration in coronavirus disease 2019 ICU patients. One-hundred six measurements in 19 ICU patients were collected. Despite enoxaparin 60 mg once daily, only two measurements of the trough anti-Xa were in the upper end of prophylactic range. Anti-Xa activity peaks increased significantly after administration, but all measurements were under the optimal prophylactic ranges. Despite an adapted protocol, three of the 19 patients (16%) developed venous thromboembolism. We show in coronavirus disease 2019 ICU patients, despite higher prophylactic low-molecular-weight heparin administration due to body mass index, anti-Xa activity was well below peak serum levels in our cohort of critically ill coronavirus disease 2019 patients. This evaluation suggests the need for rapid studies on adequate thromboprophylaxis in these patients.
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