Thromboprophylaxis in COVID-19: Anti-FXa—the Missing Factor?

Dutt, Tina; Simcox, David; Downey, Colin; McLenaghan, Daniella; King, Charlotte; Gautam, Manish; Lane, Steven; Burhan, Hassan

doi:10.1164/rccm.202005-1654le

Cited by 41 publications

(49 citation statements)

References 12 publications

(14 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Indeed, it has also been recently discovered that prophylactic LMWH dosing was associated with subtherapeutic anti-factor Xa levels among COVID-19 patients admitted to intensive care units. Dutt et al [32] reported that 95% of COVID-19 patients had sub-therapeutic anti-factor Xa levels despite prophylactic LMWH, a figure which was about 3.5 times higher compared to the patients admitted to medical wards (27%).…”

Section: Discussionmentioning

confidence: 98%

Venous thromboembolism in critically ill COVID-19 patients receiving prophylactic or therapeutic anticoagulation: a systematic review and meta-analysis

Hasan

Radford

Kow

et al. 2020

J Thromb Thrombolysis

101

View full text Add to dashboard Cite

Many aspects of care such as management of hypercoagulable state in COVID-19 patients, especially those admitted to intensive care units is challenging in the rapidly evolving pandemic of novel coronavirus disease 2019 (COVID-19). We seek to systematically review the available evidence regarding the anticoagulation approach to prevent venous thromboembolism (VTE) among COVID-19 patients admitted to intensive care units. Electronic databases were searched for studies reporting venous thromboembolic events in patients admitted to the intensive care unit receiving any type of anticoagulation (prophylactic or therapeutic). The pooled prevalence (and 95% confidence interval [CI]) of VTE among patients receiving anticoagulant were calculated using the random-effects model. Subgroup pooled analyses were performed with studies reported prophylactic anticoagulation alone and with studies reported mixed prophylactic and therapeutic anticoagulation. We included twelve studies (8 Europe; 2 UK; 1 each from the US and China) in our systematic review and meta-analysis. All studies utilized LMWH or unfractionated heparin as their pharmacologic thromboprophylaxis, either prophylactic doses or therapeutic doses. Seven studies reported on the proportion of patients with the previous history of VTE (range 0–10%). The pooled prevalence of VTE among ICU patients receiving prophylactic or therapeutic anticoagulation across all studies was 31% (95% CI 20–43%). Subgroup pooled analysis limited to studies reported prophylactic anticoagulation alone and mixed (therapeutic and prophylactic anticoagulation) reported pooled prevalences of VTE of 38% (95% CI 10–70%) and 27% (95% CI 17–40%) respectively. With a high prevalence of thromboprophylaxis failure among COVID-19 patients admitted to intensive care units, individualised rather than protocolised VTE thromboprophylaxis would appear prudent at interim.

show abstract

Section: Discussionmentioning

confidence: 98%

Venous thromboembolism in critically ill COVID-19 patients receiving prophylactic or therapeutic anticoagulation: a systematic review and meta-analysis

Hasan

Radford

Kow

et al. 2020

J Thromb Thrombolysis

101

View full text Add to dashboard Cite

show abstract

“…In our small sample of SARS-CoV-2-positive patients admitted to our sub-intensive ward, we have observed a significantly elevated prevalence of patients failing to achieve an effective anti-Xa activity (41.3%); this value sits in between the prevalence previously reported in ICU and normal wards [ 2 , 3 ], leading to hypothesize a positive correlation between the disease severity and hampered heparin effectiveness.…”

mentioning

confidence: 47%

“…A worryingly increased incidence of thrombotic events has been reported among patients suffering from COVID-19 despite standard antithrombotic prophylaxis [ 1 ]. This observation came along with more recent alerts regarding extremely high prevalence of SARS-CoV-2-positive patients admitted in intensive care units (ICU) failing to achieve the target inhibition of the activated factor X (anti-Xa): 95–100% compared to 27% in internal wards [ 2 , 3 ]. These findings can be explained by several coagulopathy and pro-thrombotic mechanisms induced by SARS-CoV-2 that lead to heparin resistance and decreased recovery of anti-Xa activity [ [3] , [4] , [5] ].…”

mentioning

confidence: 99%

Anti-Xa monitoring improves low-molecular-weight heparin effectiveness in patients with SARS-CoV-2 infection

Trunfio

Salvador

Cabodi

et al. 2020

Thrombosis Research

View full text Add to dashboard Cite

“…In a similar manner, Dutt et al 21 noted that 27% of patients with non-severe SARS-CoV-2 infection who were given prophylactic doses of heparin had anti-factor Xa activity below the level indicative of prophylaxis efficacy. Among the more serious patients, in intensive care, the percentage was 95%.…”

Section: Sars-cov-2 Infection Thrombotic Events and Heparin Resistancementioning

confidence: 84%

Fisiopatologia da trombose associada à infecção pelo SARS-CoV-2

Casella

2020

J. vasc. bras.

View full text Add to dashboard Cite

Thromboprophylaxis in COVID-19: Anti-FXa—the Missing Factor?

Cited by 41 publications

References 12 publications

Venous thromboembolism in critically ill COVID-19 patients receiving prophylactic or therapeutic anticoagulation: a systematic review and meta-analysis

Venous thromboembolism in critically ill COVID-19 patients receiving prophylactic or therapeutic anticoagulation: a systematic review and meta-analysis

Anti-Xa monitoring improves low-molecular-weight heparin effectiveness in patients with SARS-CoV-2 infection

Fisiopatologia da trombose associada à infecção pelo SARS-CoV-2

Contact Info

Product

Resources

About