Enoxaparin sodium
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Lack of efficacy in deep vein thrombosis prophylaxis: 3 case reports In a case report, three patients (2 men and 1 woman) aged 52–68 years hospitalised in the USA with coronavirus disease (COVID-19) were described, who developed pulmonary embolism (PE) despite treatment with enoxaparin sodium for venous thromboembolism (VTE) prophylaxis. Case 1: A 52-year-old man, who had a history of smoking and asthma, presented to hospital after 12 days after onset of respiratory symptoms. On admission, he reported difficulty breathing and chest tightness. Based on laboratory findings, he was diagnosed with coronavirus disease (COVID-19). Therefore, he started receiving off label treatment with hydroxychloroquine for 5 days and azithromycin. He had been receiving SC enoxaparin sodium 40 mg/day as prophylaxis against VTE. However, his respiratory symptoms continued to progress. On day 6 of admission, his d-dimer level was found to be increased. Based on his laboratory findings, a cytokine storm phase was suspected in the setting of COVID-19. Therefore, he received off label treatment with IV methylprednisolone [Solumedrol] daily for 8 days and one dose of IV tocilizumab 400mg. Subsequently, his condition improved requiring no intubation. However, his respiratory symptoms such as exertional dyspnoea, worsening hypotension, shortness of breath and chest discomfort continued to progress. On day 6 of admission, his d-dimer level was found to be increased. Based on his laboratory findings, a cytokine storm phase was suspected. Therefore, he received off label treatment with IV methylprednisolone sodium succinate [Solumedrol] daily for 8 days and one dose of IV tocilizumab 400mg. On the same day, a computed tomography angiogram (CTA) revealed bilateral PEs despite enoxaparin sodium. He was given SC enoxaparin sodium 1 mg/kg twice daily, transitioned to rivaroxaban, and was discharged on supplemental oxygen. Case 2: A 60-year-old woman was hospitalised on day 8 after onset of respiratory symptoms. She was nonsmoker and had a history of provoked deep vein thrombosis (DVT) 18 years earlier, chronic bronchitis, ovarian cancer and oophorectomy. On admission, she reported nausea, worsening cough and loss of sense of smell. Based on laboratory findings, she was diagnosed COVID-19. Therefore, she started receiving off label treatment with hydroxychloroquine for 5 days and azithromycin. She had been receiving SC enoxaparin sodium 40 mg/day as prophylaxis against VTE. However, her symptoms such as hypoxia, tachycardia and hypotension continued to progress. On day 10 of admission, her d-dimer level was found to be increased. Based on her laboratory findings, a cytokine storm phase was suspected in the setting of COVID-19. Therefore, she received off label treatment with IV methylprednisolone sodium succinate [Solumedrol] daily for 5 days and one dose of IV tocilizumab 400mg. The dose of enoxaparin sodium was adjusted to 1mg twice a day on day 10. On the same day, a CTA revealed multiple bilateral segmental and subsegmental PEs with suggestio
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