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Intermediate Doses of LMWH Appear Safe in Older COVID-19 Patients

Emerging research suggests that anticoagulation therapy is associated with better outcomes in some patients with severe COVID-19 patients. But what about those who are older or who have co-morbidities and are at higher risk of bleeding? Find out what Italian researchers determined when they looked at the effect of intermediate doses of low molecular weight heparin.

PESARO, ITALY – One emerging issue in treatment of coronavirus disease-19 (COVID-19) is the importance of coagulopathy. Researchers suggest that the  abnormal inflammatory response of the host to infection and the cytokine storm may play a crucial role in the endothelial dysfunction that ends up in a hypercoagulability state

Some studies indicate that anticoagulation therapy is associated with a better outcome in COVID-19 septic patients.

While anticoagulation at high doses might become the standard-of-care in the treatment of COVID-19, a new study questions whether that approach will be feasible and safe in all patients. The report in the Journal of Thrombosis & Thrombolysis points out that  the risk of bleeding could be a barrier, especially in older and comorbid patients.

In light of that, Italian researchers from Ospedali Riuniti Marche Nord retrospectively analyzed a cohort of hospitalized COVID-19 patients who received intermediate doses of low molecular weight heparin (LMWH) focusing on feasibility and safety.

Included in the study were 105 hospitalized patients, 61 male and 44 female with a mean age of 73.7. Patients were treated with subcutaneous enoxaparin: 80 mg/day in normal weight and mild-to-moderate impair or normal renal function; 40 mg/day in severe chronic renal failure or low bodyweight (< 45 kg); 100 mg/day was dosed if bodyweight was higher than 100 kg.

Authors note that all the patients had radiologically confirmed pneumonia and 63.8% had severe COVID-19.

Results indicate that none of the patients had fatal hemorrhage, although two (1.9%) patients had a major bleeding event --one spontaneous hematoma and one gastrointestinal bleeding. Only 6.7% of patients needed transfusions of red blood cells. One thrombotic event (pulmonary embolism) was observed.

Researchers advise that, when compared to younger patients, patients older than 85 years had a higher mortality (40% vs 13.3%), but not an increased risk of bleeding or need for blood transfusion.

“The use of an intermediate dose of LWMH appears to be feasible and data suggest safety in COVID-19 patients, although further studies are needed,” the authors conclude.