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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...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2021
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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. |
format | Online Article Text |
id | pubmed-7778858 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
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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