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Updated: Oct 8, 2025

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Heparin and SARS-CoV-2: Multiple Pathophysiological Links.

Pierpaolo Di Micco1, Egidio Imbalzano2, Vincenzo Russo3

  • 1Department of Medicine, Buon Consiglio Fatebenefratelli Hospital of Naples, 80122 Naples, Italy.

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PubMed
Summary

Enoxaparin, a low molecular weight heparin, shows antiviral and anticoagulant benefits for COVID-19 patients. However, its use is associated with an increased risk of bleeding, necessitating careful patient selection and monitoring.

Keywords:
COVID-19bleedingsfondaparinuxheparinslow molecular weight heparinvenous thromboembolism

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Area of Science:

  • Pharmacology
  • Virology
  • Hematology

Background:

  • Low molecular weight heparin (LMWH), specifically enoxaparin, has been widely utilized during the SARS-CoV-2 pandemic.
  • Heparin's pharmacological properties include binding viruses in the respiratory tract and preventing venous thromboembolism (VTE).

Purpose of the Study:

  • To review the antithrombotic actions of enoxaparin in COVID-19 patients.
  • To assess the efficacy and risks associated with enoxaparin use in hospitalized COVID-19 patients.

Main Methods:

  • Review of existing literature on enoxaparin use in COVID-19 patients.
  • Analysis of clinical data regarding prophylactic and therapeutic doses of enoxaparin.

Main Results:

  • Enoxaparin demonstrated antithrombotic effects in both general ward and Intensive Care Unit (ICU) COVID-19 patients.
  • Prophylactic doses were effective for VTE prevention in non-ICU patients; intermediate or therapeutic doses were used in ICUs.
  • An increased incidence of bleeding events was observed, linked to patient comorbidities, dosage, and duration of enoxaparin administration.

Conclusions:

  • Enoxaparin offers significant antithrombotic benefits for COVID-19 inpatients.
  • The risk of bleeding associated with enoxaparin necessitates careful consideration of patient-specific factors and treatment protocols.