Cargando…
The Impact of Risk-Adjusted Heparin Regimens on the Outcome of Patients with COVID-19 Infection. A Prospective Cohort Study
Background. According to recent guidelines, all hospitalized patients with COVID-19 should receive pharmacological prophylaxis for venous thromboembolism (VTE), unless there are specific contraindications. However, the optimal preventive strategy in terms of intensity of anticoagulation for these pa...
Autores principales: | , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8473366/ https://www.ncbi.nlm.nih.gov/pubmed/34578301 http://dx.doi.org/10.3390/v13091720 |
_version_ | 1784574973842554880 |
---|---|
author | Di Micco, Pierpaolo Tufano, Antonella Cardillo, Giuseppe Imbalzano, Egidio Amitrano, Maria Lodigiani, Corrado Bellizzi, Annamaria Camporese, Giuseppe Cavalli, Antonella De Stefano, Carmela Russo, Vincenzo Voza, Antonio Perrella, Alessandro Prandoni, Paolo |
author_facet | Di Micco, Pierpaolo Tufano, Antonella Cardillo, Giuseppe Imbalzano, Egidio Amitrano, Maria Lodigiani, Corrado Bellizzi, Annamaria Camporese, Giuseppe Cavalli, Antonella De Stefano, Carmela Russo, Vincenzo Voza, Antonio Perrella, Alessandro Prandoni, Paolo |
author_sort | Di Micco, Pierpaolo |
collection | PubMed |
description | Background. According to recent guidelines, all hospitalized patients with COVID-19 should receive pharmacological prophylaxis for venous thromboembolism (VTE), unless there are specific contraindications. However, the optimal preventive strategy in terms of intensity of anticoagulation for these patients is not well established. Objectives. To investigate the impact of individualized regimens of enoxaparin on the development of VTE and on the risk of major bleeding complications during hospitalization in patients with COVID-19 infection. Methods. All consecutive patients admitted to the medical wards of six Italian hospitals between 15 September and 15 October 2020 with COVID-19 infection of moderate severity were administered enoxaparin in subcutaneous daily doses adjusted to the Padua Prediction Score stratification model: No heparin in patients scoring less than 4, 4000 IU daily in those scoring 4, 6000 IU in those scoring 5, and 8000 in those scoring six or more. Objective tests were performed in patients developing clinical symptoms of deep vein thrombosis and/or pulmonary embolism. Bleeding complications were defined according to the ISTH classification. Results. From the 154 eligible patients, enoxaparin was administered in all: 4000 IU in 73 patients, 6000 IU in 53, and 8000 IU in the remaining 28. During the course of hospitalization, 27 patients (17.5%) died. VTE developed in 14 of the 154 patients (9.1%; 95% CI, 4.6% to 13.6%), and was fatal in 1. Major bleeding complications developed in 35 patients (22.7%; 95% CI, 16.1% to 29.3%), and were fatal in 8. Conclusions. Despite the use of risk-adjusted doses of enoxaparin, the rate of VTE events was consistent with that reported in contemporary studies where fixed-dose low-molecular-weight heparin was used. The unexpectedly high risk of bleeding complications should induce caution in administering enoxaparin in doses higher than the conventional low ones. |
format | Online Article Text |
id | pubmed-8473366 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-84733662021-09-28 The Impact of Risk-Adjusted Heparin Regimens on the Outcome of Patients with COVID-19 Infection. A Prospective Cohort Study Di Micco, Pierpaolo Tufano, Antonella Cardillo, Giuseppe Imbalzano, Egidio Amitrano, Maria Lodigiani, Corrado Bellizzi, Annamaria Camporese, Giuseppe Cavalli, Antonella De Stefano, Carmela Russo, Vincenzo Voza, Antonio Perrella, Alessandro Prandoni, Paolo Viruses Brief Report Background. According to recent guidelines, all hospitalized patients with COVID-19 should receive pharmacological prophylaxis for venous thromboembolism (VTE), unless there are specific contraindications. However, the optimal preventive strategy in terms of intensity of anticoagulation for these patients is not well established. Objectives. To investigate the impact of individualized regimens of enoxaparin on the development of VTE and on the risk of major bleeding complications during hospitalization in patients with COVID-19 infection. Methods. All consecutive patients admitted to the medical wards of six Italian hospitals between 15 September and 15 October 2020 with COVID-19 infection of moderate severity were administered enoxaparin in subcutaneous daily doses adjusted to the Padua Prediction Score stratification model: No heparin in patients scoring less than 4, 4000 IU daily in those scoring 4, 6000 IU in those scoring 5, and 8000 in those scoring six or more. Objective tests were performed in patients developing clinical symptoms of deep vein thrombosis and/or pulmonary embolism. Bleeding complications were defined according to the ISTH classification. Results. From the 154 eligible patients, enoxaparin was administered in all: 4000 IU in 73 patients, 6000 IU in 53, and 8000 IU in the remaining 28. During the course of hospitalization, 27 patients (17.5%) died. VTE developed in 14 of the 154 patients (9.1%; 95% CI, 4.6% to 13.6%), and was fatal in 1. Major bleeding complications developed in 35 patients (22.7%; 95% CI, 16.1% to 29.3%), and were fatal in 8. Conclusions. Despite the use of risk-adjusted doses of enoxaparin, the rate of VTE events was consistent with that reported in contemporary studies where fixed-dose low-molecular-weight heparin was used. The unexpectedly high risk of bleeding complications should induce caution in administering enoxaparin in doses higher than the conventional low ones. MDPI 2021-08-30 /pmc/articles/PMC8473366/ /pubmed/34578301 http://dx.doi.org/10.3390/v13091720 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Brief Report Di Micco, Pierpaolo Tufano, Antonella Cardillo, Giuseppe Imbalzano, Egidio Amitrano, Maria Lodigiani, Corrado Bellizzi, Annamaria Camporese, Giuseppe Cavalli, Antonella De Stefano, Carmela Russo, Vincenzo Voza, Antonio Perrella, Alessandro Prandoni, Paolo The Impact of Risk-Adjusted Heparin Regimens on the Outcome of Patients with COVID-19 Infection. A Prospective Cohort Study |
title | The Impact of Risk-Adjusted Heparin Regimens on the Outcome of Patients with COVID-19 Infection. A Prospective Cohort Study |
title_full | The Impact of Risk-Adjusted Heparin Regimens on the Outcome of Patients with COVID-19 Infection. A Prospective Cohort Study |
title_fullStr | The Impact of Risk-Adjusted Heparin Regimens on the Outcome of Patients with COVID-19 Infection. A Prospective Cohort Study |
title_full_unstemmed | The Impact of Risk-Adjusted Heparin Regimens on the Outcome of Patients with COVID-19 Infection. A Prospective Cohort Study |
title_short | The Impact of Risk-Adjusted Heparin Regimens on the Outcome of Patients with COVID-19 Infection. A Prospective Cohort Study |
title_sort | impact of risk-adjusted heparin regimens on the outcome of patients with covid-19 infection. a prospective cohort study |
topic | Brief Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8473366/ https://www.ncbi.nlm.nih.gov/pubmed/34578301 http://dx.doi.org/10.3390/v13091720 |
work_keys_str_mv | AT dimiccopierpaolo theimpactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT tufanoantonella theimpactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT cardillogiuseppe theimpactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT imbalzanoegidio theimpactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT amitranomaria theimpactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT lodigianicorrado theimpactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT bellizziannamaria theimpactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT camporesegiuseppe theimpactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT cavalliantonella theimpactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT destefanocarmela theimpactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT russovincenzo theimpactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT vozaantonio theimpactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT perrellaalessandro theimpactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT prandonipaolo theimpactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT dimiccopierpaolo impactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT tufanoantonella impactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT cardillogiuseppe impactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT imbalzanoegidio impactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT amitranomaria impactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT lodigianicorrado impactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT bellizziannamaria impactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT camporesegiuseppe impactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT cavalliantonella impactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT destefanocarmela impactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT russovincenzo impactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT vozaantonio impactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT perrellaalessandro impactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy AT prandonipaolo impactofriskadjustedheparinregimensontheoutcomeofpatientswithcovid19infectionaprospectivecohortstudy |