Bleeding prevalence in COVID-19 patients receiving intensive antithrombotic prophylaxis
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LETTER TO THE EDITOR
Bleeding prevalence in COVID‑19 patients receiving intensive antithrombotic prophylaxis Chiara Kessler1 · Hans Stricker2 · Daniela Demundo3 · Luigia Elzi4 · Rita Monotti5 · Giorgia Bianchi6 · Michael Llamas7 · Luca Spinedi2 · Davide Rossi1 · Alessandro Felice Chiesa7 · Alberto Pagnamenta7 · Marco Conti7 · Gabriele Casso8 · Elisa Stoira5 · Elisa Valenti7 · Giuseppe Colucci9 · Georg Stussi1 · Bernhard Gerber1 · Marco Previsdomini7
© Springer Science+Business Media, LLC, part of Springer Nature 2020
To the editor In-hospital patients with severe acute respiratory syndrome coronavirus 2-induced disease (COVID-19) have a high risk of thrombosis [1–4]. Pharmacological thromboprophylaxis is strongly encouraged, and several experts even suggest the use of high-dose prophylaxis or full anticoagulation for patients with severe disease at low risk of bleeding, but up to now, data on safety of this approach are lacking [1, 5–8]. Here, we report observational single-center prevalence of major bleeding events (ISTH definition, Table S1) in patients with COVID-19 receiving intensive thromboprophylaxis [9]. We included all consecutive adult patients with laboratoryproven COVID-19 treated between April 1st and May 6th 2020 at the Hospital La Carità, Locarno, Switzerland. On April 1st 2020, we have implemented the following intensive Bernhard Gerber and Marco Previsdomini contributed equally and are listed alphabetically. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11239-020-02244-y) contains supplementary material, which is available to authorized users. * Bernhard Gerber [email protected] 1
thromboprophylaxis scheme: Patients with COVID-19 with an estimated glomerular filtration rate (eGFR) ≥ 30 ml/ min/1.73 m2 received subcutaneous enoxaparin twice daily (BID) at a dose of 40 mg (< 80 kg), or 60 mg (≥ 80 kg) for a minimum of 14 days (dose level 1). Dose escalation to 60 mg BID (< 80 kg), or 80 mg BID (≥ 80 kg) was discussed if D-dimer levels increased during follow-up > 2.0 mg/L, irrespective of the presence of thromboembolic complications (dose level 2). Patients with COVID-19 with an eGFR < 30 ml/min/1.73 m2 received subcutaneous UFH at a dose of 5000 IU three times a day in the regular ward, or continuous intravenous UFH in the intensive care unit (ICU) with a target anti-Xa activity of 0.3–0.5 U/ml. The study was approved by the Ethical Committee Ticino, Switzerland (2020-00838 RIF.CE 3621). A total of 270 inpatients with confirmed COVID-19 were eligible for this analysis. 22 (8.2%) patients received regular thromboprophylaxis with once daily enoxaparin 40 mg or UFH 5000 IU two times a day, 183 (67.8%) patients received the intensified thromboprophylaxis, and 65 (24%) patients had full anticoagulation (Table 1). Of the 65 patients with therapeutic anticoagulation, 20 6
Department of Nephrology, Ospedale La Carità, Locarno, Switzerland
7
Department of Intensive Care Medicine of the Ente Ospedaliero Cantonale (EOC), Intensiv
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