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

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