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Increasing dosages of low-molecular-weight heparin in hospitalized patients with Covid-19

We conducted an observational cohort study in adult patients consecutively admitted for the respiratory illness Covid-19 to our hub hospital from March 9 to April 7, 2020. The high observed rate of venous thromboembolism prompted us to increase the prophylactic doses of enoxaparin from 40 mg daily u...

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Autores principales: Martinelli, Ida, Ciavarella, Alessandro, Abbattista, Maria, Aliberti, Stefano, De Zan, Valentina, Folli, Christian, Panigada, Mauro, Gori, Andrea, Artoni, Andrea, Ierardi, Anna Maria, Carrafiello, Gianpaolo, Monzani, Valter, Grasselli, Giacomo, Blasi, Francesco, Peyvandi, Flora
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7778858/
https://www.ncbi.nlm.nih.gov/pubmed/33389568
http://dx.doi.org/10.1007/s11739-020-02585-9
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author Martinelli, Ida
Ciavarella, Alessandro
Abbattista, Maria
Aliberti, Stefano
De Zan, Valentina
Folli, Christian
Panigada, Mauro
Gori, Andrea
Artoni, Andrea
Ierardi, Anna Maria
Carrafiello, Gianpaolo
Monzani, Valter
Grasselli, Giacomo
Blasi, Francesco
Peyvandi, Flora
author_facet Martinelli, Ida
Ciavarella, Alessandro
Abbattista, Maria
Aliberti, Stefano
De Zan, Valentina
Folli, Christian
Panigada, Mauro
Gori, Andrea
Artoni, Andrea
Ierardi, Anna Maria
Carrafiello, Gianpaolo
Monzani, Valter
Grasselli, Giacomo
Blasi, Francesco
Peyvandi, Flora
author_sort Martinelli, Ida
collection PubMed
description We conducted an observational cohort study in adult patients consecutively admitted for the respiratory illness Covid-19 to our hub hospital from March 9 to April 7, 2020. The high observed rate of venous thromboembolism prompted us to increase the prophylactic doses of enoxaparin from 40 mg daily up to 1 mg/kg twice daily in patients admitted to intensive care units (ICU), 0.7 mg/kg twice daily in high-intensity of care wards and 1 mg/kg daily in low-intensity of care wards. Patients on high enoxaparin doses were compared to those who received prophylaxis with the standard dosage. Efficacy endpoints were mortality, clinical deterioration, and the occurrence of venous thromboembolism, safety endpoint was the occurrence of major bleeding. Of 278 patients with Covid-19, 127 received prophylaxis with high enoxaparin doses and 151 with standard dosage. At 21 days, the incidence rate of death and clinical deterioration were lower in patients on higher doses than in those on the standard dosage (hazard ratio 0.39, 95% confidence interval 0.23–0.62), and the incidence of venous thromboembolism was also lower (hazard ratio 0.52, 95% confidence interval 0.26–1.05). Major bleeding occurred in four of 127 patients (3.1%) on the high enoxaparin dosage. In conclusion, in the cohort of patients with Covid-19 treated with high enoxaparin dosages we observed a 60% reduction of mortality and clinical deterioration and a 50% reduction of venous thromboembolism compared to standard dosage prophylaxis. However, 3% of patients on high enoxaparin dosages had non-fatal major bleeding. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11739-020-02585-9.
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spelling pubmed-77788582021-01-04 Increasing dosages of low-molecular-weight heparin in hospitalized patients with Covid-19 Martinelli, Ida Ciavarella, Alessandro Abbattista, Maria Aliberti, Stefano De Zan, Valentina Folli, Christian Panigada, Mauro Gori, Andrea Artoni, Andrea Ierardi, Anna Maria Carrafiello, Gianpaolo Monzani, Valter Grasselli, Giacomo Blasi, Francesco Peyvandi, Flora Intern Emerg Med Im - Original We conducted an observational cohort study in adult patients consecutively admitted for the respiratory illness Covid-19 to our hub hospital from March 9 to April 7, 2020. The high observed rate of venous thromboembolism prompted us to increase the prophylactic doses of enoxaparin from 40 mg daily up to 1 mg/kg twice daily in patients admitted to intensive care units (ICU), 0.7 mg/kg twice daily in high-intensity of care wards and 1 mg/kg daily in low-intensity of care wards. Patients on high enoxaparin doses were compared to those who received prophylaxis with the standard dosage. Efficacy endpoints were mortality, clinical deterioration, and the occurrence of venous thromboembolism, safety endpoint was the occurrence of major bleeding. Of 278 patients with Covid-19, 127 received prophylaxis with high enoxaparin doses and 151 with standard dosage. At 21 days, the incidence rate of death and clinical deterioration were lower in patients on higher doses than in those on the standard dosage (hazard ratio 0.39, 95% confidence interval 0.23–0.62), and the incidence of venous thromboembolism was also lower (hazard ratio 0.52, 95% confidence interval 0.26–1.05). Major bleeding occurred in four of 127 patients (3.1%) on the high enoxaparin dosage. In conclusion, in the cohort of patients with Covid-19 treated with high enoxaparin dosages we observed a 60% reduction of mortality and clinical deterioration and a 50% reduction of venous thromboembolism compared to standard dosage prophylaxis. However, 3% of patients on high enoxaparin dosages had non-fatal major bleeding. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11739-020-02585-9. Springer International Publishing 2021-01-03 2021 /pmc/articles/PMC7778858/ /pubmed/33389568 http://dx.doi.org/10.1007/s11739-020-02585-9 Text en © Società Italiana di Medicina Interna (SIMI) 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Im - Original
Martinelli, Ida
Ciavarella, Alessandro
Abbattista, Maria
Aliberti, Stefano
De Zan, Valentina
Folli, Christian
Panigada, Mauro
Gori, Andrea
Artoni, Andrea
Ierardi, Anna Maria
Carrafiello, Gianpaolo
Monzani, Valter
Grasselli, Giacomo
Blasi, Francesco
Peyvandi, Flora
Increasing dosages of low-molecular-weight heparin in hospitalized patients with Covid-19
title Increasing dosages of low-molecular-weight heparin in hospitalized patients with Covid-19
title_full Increasing dosages of low-molecular-weight heparin in hospitalized patients with Covid-19
title_fullStr Increasing dosages of low-molecular-weight heparin in hospitalized patients with Covid-19
title_full_unstemmed Increasing dosages of low-molecular-weight heparin in hospitalized patients with Covid-19
title_short Increasing dosages of low-molecular-weight heparin in hospitalized patients with Covid-19
title_sort increasing dosages of low-molecular-weight heparin in hospitalized patients with covid-19
topic Im - Original
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7778858/
https://www.ncbi.nlm.nih.gov/pubmed/33389568
http://dx.doi.org/10.1007/s11739-020-02585-9
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