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Anti Xa activity after high dose LMWH thrombosis prophylaxis in covid 19 patients at the intensive care unit

E A Vlot1, E J Van den Dool2, C M Hackeng2

  • 1Department of Anesthesiology, Intensive Care and Pain medicine, St Antonius Hospital, the Netherlands.

Thrombosis Research
|August 18, 2020
PubMed

Insights

High-dose low molecular weight heparin (LMWH) prophylaxis in intensive care unit (ICU) patients with Coronavirus disease 2019 (COVID-19) achieved target anti-factor Xa levels but viscoelastic tests indicated a procoagulant state.

Area of Science:

  • Critical Care Medicine
  • Hematology
  • Infectious Diseases

Background:

  • Coronavirus disease 2019 (COVID-19) is associated with coagulopathy, characterized by elevated D-dimer, prothrombin time (PT), fibrinogen, and factor VIII.
  • Venous thromboembolic events are frequent complications in COVID-19 patients.
  • This study investigates the efficacy of high-dose nadroparin low molecular weight heparin (LMWH) for thrombosis prophylaxis in intensive care unit (ICU) settings.

Discussion:

  • Nadroparin LMWH at 5700 IU twice daily achieved therapeutic anti-factor Xa (anti-Xa) concentrations in COVID-19 ICU patients.
  • Routine coagulation tests revealed normal PT, antithrombin (AT), and platelet counts, but increased D-dimer and fibrinogen.
  • Viscoelastic hemostatic tests indicated a hypercoagulable state, with increased clot strength and a high fibrin contribution.

Key Insights:

  • Pharmacodynamic monitoring confirmed therapeutic anti-Xa activity within the target range for COVID-19 patients.
  • Despite achieving therapeutic anticoagulation, viscoelastic tests consistently showed a procoagulant pattern.
  • The findings suggest that standard anticoagulation may not fully normalize the hypercoagulable state observed in severe COVID-19.

Outlook:

  • Further research is needed to elucidate the specific mechanisms driving the persistent procoagulant state in COVID-19 patients on LMWH.
  • Investigating alternative or adjunctive antithrombotic strategies may be warranted for optimizing thrombosis prevention in this population.
  • Long-term studies assessing the clinical outcomes and bleeding risks associated with this prophylaxis regimen are essential.
Abstract

Keywords:
Anti Xa activityCovid-19Thrombosis prophylaxis managementViscoelastic coagulation tests

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