Sep
2020

Routine venous thromboembolism prophylaxis may be inadequate in the hypercoagulable state of severe coronavirus disease 2019.

Maatman TK, Jalali F, Feizpour C, et al.
Crit Care Med 2020;48:e783-e790.
NATA Rating :
Review by : C. M. Samama
NATA Review

This observationnal study has included 240 consecutive patients with confirmed severe acute respiratory syndrome coronavirus 2 infection  admitted to one of three hospitals. One-hundred nine critically ill COVID 19 patients admitted to the ICU were included in the analysis. 

Venous thromboembolism was diagnosed in 31 patients (28%) 8 ± 7 days after hospital admission, including two patients diagnosed with venous thromboembolism at presentation to the hospital. Elevated admission D-dimer and peak D-dimer were associated with venous thromboembolism development (P < 0.05). Hypercoagulability was also confirmed by thromboelastography.

Routine pharmacological venous thromboembolism prophylaxis was given to all patients and it appears that a prophylactic dose may be inadequate. Several ongoing studies are comparing preventive dosing with therapeutic dosing (LMWH). The answer may also be found in intermediate dosing, as evaluated in another study.

– Charles Marc Samama