Original article

Blood Transfusion - 6 2022 (November-December)

Clinical evaluation of the safety and efficacy of enoxaparin in patients with COVID-19

Authors

Key words: enoxaparin, COVID-19, thrombosis
Publication Date: 2021-12-13

Abstract

Background - Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), increases thrombotic risk in hospitalised patients. The rate of thrombosis in patients with COVID-19 is unclear. The role of heparin, frequently used in the management of hospitalised patients, also needs to be clarified. In this study, we investigated the efficacy and
safety of enoxaparin given at prophylactic or therapeutic dose in hospitalised patients with COVID-19, and evaluated its role in the development of disease in terms of mortality, and incidence of thrombotic and bleeding events.
Material and methods - We included 141 patients with SARS-CoV-2 infection, admitted to five different wards (one intensive care unit, 2 sub-intensive care units, and 2 general infectious disease units) of Cotugno Hospital, a tertiary care hospital in Naples, Italy, between March and May 2020.
Results - Over a median time of 17 days (IQR 11-25), enoxaparin was given to 90/141 patients (63.8%) of whom 65 took a prophylactic and 25 a therapeutic dose. We documented 14 episodes of thrombosis (9.9%); almost all were cases of pulmonary embolism. No significant difference in terms of thromboembolic prevention was found between those patients not receiving anticoagulants and those on prophylactic or therapeutic dose of enoxaparin. Five episodes of major bleeding occurred (3.5%); therapeutic dose of enoxaparin was associated with a greater bleeding risk than prophylactic dose (p=0.002). During follow-up, 31 patients (22%) died; these were mostly elderly men with two or more comorbidities at admission. No advantages of enoxaparin, either as prophylaxis or at high doses, in terms of mortality were observed. At multivariate analysis, low estimated glomerular filtration rate, and high total bilirubin and fasting hyperglycemia were independently associated with a higher mortality.
Discussion - We did not observe advantages in terms of either thromboembolic prevention or mortality of enoxaparin, which however was more frequently used in patients with more severe disease. Prophylactic enoxaparin was not seen to be associated with bleeding risk.

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Authors

Rosina Albisinni - Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy

Martina Vitrone - Department of Advanced Medical and Surgical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy

Maria P. Ursi - Department of Advanced Medical and Surgical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy

Serenella Spiezia - Department of Advanced Medical and Surgical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy

Anna Salemme - Department of Advanced Medical and Surgical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy

Letizia L. Florio - Department of Advanced Medical and Surgical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy

Filomena Boccia - Department of Advanced Medical and Surgical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy

Domenico Iossa - Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy

Rosa Zampino - Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy; Department of Advanced Medical and Surgical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy

Luigi Atripaldi - Unit of Microbiology and Virology, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy

Francesco Squillante - II COVID Unit, AORN Ospedali dei Colli, Cotugno Hospital, Naples, Italy

Nicola Maturo - III COVID Unit, AORN Ospedali dei Colli, Cotugno Hospital, Naples, Italy

Fiorentino Fraganza - Emergency Infectious Disease, AORN Ospedali dei Colli, Cotugno Hospital, Naples, Italy

Sergio Severino - Unit of Cardiology, AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy

Rodolfo Punzi - Department of Infectious diseases, AORN Ospedali dei Colli, Cotugno Hospital, Naples, Italy

Giuseppe Fiorentino - I COVID Unit, of AORN Ospedali dei Colli, Cotugno Hospital, Naples, Italy

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