A Dynamic, D-dimer-based Thromboprophylaxis Strategy in Patients with COVID-19

Area of Science:

• Internal Medicine
• Hematology
• Infectious Diseases

Background:

• COVID-19 infection is associated with an increased risk of venous thromboembolism (VTE) during hospitalization.
• Standard prophylactic anticoagulation may be insufficient to mitigate VTE risk in these patients.
• Limited diagnostic imaging during the pandemic necessitates optimized anticoagulant management protocols.

Purpose of the Study:

• To evaluate the efficacy and safety of a dynamic anticoagulation dosing protocol based on D-dimer levels in hospitalized COVID-19 patients.
• To compare in-hospital survival rates between patients receiving fixed versus dynamically adjusted anticoagulant doses.
• To assess secondary outcomes including bleeding events, thrombosis incidence, and hospitalization duration.

Main Methods:

• Retrospective cohort study involving 260 hospitalized COVID-19 patients.
• Implementation of a quality improvement program with a D-dimer-guided anticoagulation dosing protocol.
• Patients were divided into fixed-dose and dynamic (up-titrated) anticoagulation groups.

Main Results:

• In-hospital survival at 30 days was significantly higher in the up-titrated group (80.2%) compared to the fixed-dose group (51.3%) (p=0.01).
• Bleeding events were more frequent in the up-titrated group (12.5%) versus the fixed-dose group (2.13%), primarily consisting of clinically relevant non-major bleeding (CRNMB).
• The study included assessment of breakthrough thrombosis, length of stay, and mechanical ventilation days.

Conclusions:

• Dynamic, D-dimer-based anticoagulation dose escalation shows promise for improving survival in hospitalized COVID-19 patients.
• This approach may reduce in-hospital mortality without a significant increase in fatal bleeding events.
• Optimized anticoagulation strategies are crucial for managing VTE risk in COVID-19 patients.