Preventing VTE in critically ill COVID-19 patients

Venous thromboembolism (VTE) is the most commonly reported thrombotic complication of COVID-19, with approximately 28% of critically ill patients with COVID-19 experiencing VTE. However, limited data are available to guide the intensity of antithrombotic prophylaxis.

A recent study published in JAMA evaluated the effects of intermediate-dose versus standard-dose prophylactic anticoagulation medication among patients with COVID-19 who were admitted to the ICU. The researchers found no statistically significant differences in the primary outcome between the two groups. 

Among the 562 patients included in the study, 276 patients were given intermediate-dose enoxaparin (1 mg/kg daily), while 286 patients were given standard prophylactic anticoagulation enoxaparin (40 mg daily with modification according to body weight and creatinine clearance). The primary outcome was a composite of venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days, which was assessed in randomized patients who met the eligibility criteria and received at least one dose of the assigned treatment.

The results showed that the primary outcome occurred in 45.7% of the patients given intermediate-dose enoxaparin and in 44.1% of the patients given standard-dose prophylactic enoxaparin.

Major bleeding occurred in 2.5% of patients in the intermediate-dose group and 1.4% of patients in the standard-dose prophylaxis group. Severe thrombocytopenia occurred only in patients assigned to the intermediate-dose group (six vs. zero patients).

The authors concluded that these results do not support the routine empirical use of intermediate-dose prophylactic anticoagulation in patients admitted to the ICU with COVID-19.