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Updated: Dec 12, 2025
Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
Published on: October 12, 2012
Safety of intermediate dose of low molecular weight heparin in COVID-19 patients
Massimo Mattioli1, Devis Benfaremo2, Mauro Mancini3
1UOC Pronto Soccorso e Medicina d'Urgenza, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Piazzale Cinelli, 61121, 4 Pesaro, Italy. massimo.mattioli@ospedalimarchenord.it.
Insights
Intermediate doses of low-molecular-weight heparin (LMWH) appear safe for hospitalized COVID-19 patients with pneumonia. This approach showed low rates of bleeding and thrombotic events, even in older individuals.
Area of Science:
- Internal Medicine
- Hematology
- Infectious Diseases
Background:
- Coagulopathy is a major factor in COVID-19 morbidity and mortality.
- The optimal thromboprophylaxis strategy for severe COVID-19 remains unclear.
- Investigating intermediate-dose anticoagulation is crucial for patient outcomes.
Purpose of the Study:
- To assess the safety and feasibility of intermediate-dose low-molecular-weight heparin (LMWH) regimens.
- To evaluate LMWH safety in COVID-19 patients with pneumonia, focusing on older populations.
- To determine the incidence of bleeding and thrombotic events with adjusted LMWH doses.
Main Methods:
- Retrospective evaluation of 105 hospitalized COVID-19 patients with pneumonia.
- Treatment with subcutaneous enoxaparin (LMWH) at adjusted doses based on weight and renal function.
- Data collection on bleeding events, transfusions, and thrombotic events.
Main Results:
- No fatal hemorrhages occurred; only 1.9% experienced major bleeding events.
- A low rate of red blood cell transfusions (6.7%) and one thrombotic event (pulmonary embolism) were observed.
- Patients over 85 years had higher mortality but not increased bleeding risk compared to younger patients.
Conclusions:
- Intermediate-dose LMWH appears feasible and safe for COVID-19 pneumonia patients.
- This dosing strategy warrants further investigation in larger, prospective studies.
- Adjusted LMWH dosing may be a viable option for managing coagulopathy in severe COVID-19.
Abstract:
Coagulopathy represents one of the most important determinants of morbidity and mortality in coronavirus disease-19 (COVID-19). Whether standard thromboprophylaxis is sufficient or higher doses are needed, especially in severe patients, is unknown. To evaluate the safety of intermediate dose regimens of low-weight molecular heparin (LWMH) in COVID-19 patients with pneumonia, particularly in older patients. We retrospectively evaluated 105 hospitalized patients (61 M, 44 F; mean age 73.7 years) treated with subcutaneous enoxaparin: 80 mg/day in normal weight and mild-to-moderate impair or normal renal function; 40 mg/day in severe chronic renal failure or low bodyweight (< 45 kg); 100 mg/day if bodyweight was higher than 100 kg. All the patients had radiologically confirmed pneumonia and 63.8% had severe COVID-19. None of the patients had fatal haemorrhage; two (1.9%) patients had a major bleeding event (one spontaneous hematoma and one gastrointestinal bleeding). Only 6.7% of patients needed transfusions of red blood cells. One thrombotic event (pulmonary embolism) was observed. When compared to younger patients, patients older than 85 years had a higher mortality (40% vs 13.3%), but not an increased risk of bleeding or need for blood transfusion. The use of an intermediate dose of LWMH appears to be feasible and data suggest safety in COVID-19 patients, although further studies are needed.
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