Report of Low Incidence of Thrombosis with Early Prophylaxis in Hospitalized Patients with COVID-19 from Two Saudi Tertiary Centers

Abstract

Background Thrombotic events can increase the COVID-19 associated disease mortality. The administration of prophylactic anticoagulants had been shown to decrease the incidence of thrombosis, mortality, and ICU admission rates in COVID-19 patients. Aims The present study investigates the rate of thrombosis with early anticoagulation prophylaxis, the various risk factors for thrombotic events, and the overall survival rate in hospitalized COVID-19 cases. Methods In this prospective observational study, 425 patients aged ≥14 years were included in the study who were hospitalized with COVID-19 related symptoms from March to October 2020 at two tertiary care hospitals in the Kingdom of Saudi Arabia. Venous thromboembolism (VTE) score was evaluated, and VTE prophylaxis was administered according to the hospital guidelines. Patients’ demographics, comorbidities, disease presentation, and sequential hematological profiles were also recorded. Samples were collected at different time points to determine the hematological profiles. Results Out of 425 with positive COVID-19 subjects, eight (1.9%) patients developed thrombosis during admission, with pulmonary embolism being the most common type. VTE prophylaxis was administered to 394 (92.7%) patients. These anticoagulants included enoxaparin (86.3%), heparin (12.7%), warfarin (0.8%) and apixaban (0.3%). Comorbid conditions were recorded in 253 (59.5%) patients. ICU admission rate was 28% (n = 119), with a median time to transfer to ICU of 1 day (r: 0-33 days). A trend of high VTE score (5.0) with ICU admission and mortality ( P = <.001) was observed. The observed mortality rate for our cohort was 5.9% (25 events out of 425); however, for patients admitted in ICU, it was 16% (19 events out of 119 admissions). Conclusion We are reporting a low incidence of thrombosis in COVID-19 patients. We have demonstrated that the early administration of prophylactic anticoagulants might reduce the risk of thrombotic events and the associated mortality. We observed a higher VTE score and thrombosis in patients admitted to the ICU.

Changes in the Fibrinolytic System of Patients Infected with Severe Acute Respiratory Syndrome Coronavirus 2

“…In our cohort, hypofibrinolysis was observed in 22 of 446 (4.9%) COVID-19 patients, with more cases of hypofibrinolysis than hyperfibrinolysis. A similar study reported a lower incidence of thrombosis in 1.9% of COVID-19 patients [ 14 ]. However, this finding may be due to the administration of prophylactic anticoagulants earlier in the course of the disease.…”

“…Diagnosis of SARS-CoV-2 was confirmed according to the World Health Organization guidelines, nasopharyngeal swabs with reverse transcriptase real-time polymerase chain reaction (RT-PCR) for SARS-CoV-2 were used to confirm the diagnosis of COVID-19 in all patients. According to our hospital’s guidelines for the management of COVID-19 patients, thromboprophylaxis (with unfractionated heparin or low-molecular-weight heparin) was administered to all adult patients and 50% of pediatric patients on the same day of hospital admission or two days later [ 14 ].…”

Improving guideline‐concordant thromboprophylaxis prescribing for children admitted to hospital with COVID‐19

“…Pediatric patients admitted with COVID‐19 are also at an increased risk of VTE 10–12 . In contrast to adult guidelines, pharmacologic prophylaxis is suggested for children admitted with COVID‐19 who either have an elevated D‐dimer levels or have additional risk factors for VTE 12 .…”

“…8,9 Pediatric patients admitted with COVID-19 are also at an increased risk of VTE. [10][11][12] In contrast to adult guidelines, pharmacologic prophylaxis is suggested for children admitted with COVID-19 who either have an elevated D-dimer levels or have additional risk factors for VTE. 12 In a phase 2 study of pharmacologic prophylaxis with enoxaparin in pediatric patients admitted with COVID-19, no patient experienced clinically significant bleeding.…”