Anti Xa activity after high dose LMWH thrombosis prophylaxis in covid 19 patients at the intensive care unit

E A Vlot; E J Van den Dool; C M Hackeng; M Sohne; P G Noordzij; E P A Van Dongen

doi:10.1016/j.thromres.2020.07.035

Anti Xa activity after high dose LMWH thrombosis prophylaxis in covid 19 patients at the intensive care unit

E A Vlot, E J Van den Dool, C M Hackeng, M Sohne, P G Noordzij, E P A Van Dongen

Research output: Contribution to journal › Letter › Academic › peer-review

Abstract

INTRODUCTION: Coagulopathy in Coronavirus disease 2019 (covid-19) has been demonstrated by an increase in D-dimer, prothrombin time (PT), fibrinogen and factor VIII. Venous thromboembolic events are a common abnormality in patients with covid-19. We evaluate the results of intensive care unit (ICU) thrombosis prophylaxis of 5700 international unit (IU) nadroparin low molecular weight heparin (LMWH) twice daily.

METHODS: After introduction of this high-dose pharmacological thrombosis prophylaxis twice weekly anti-factor Xa (anti Xa) concentrations and results from routine laboratory and viscoelastic hemostatic tests in 16 ICU covid-19 patients were evaluated.

RESULTS: During one week, median peak anti Xa activities were 0.38 [0.16-0.45] and 0.38 [0.20-0.58] at time point 1 and 2 respectively. Laboratory coagulation tests showed PT, AT and platelet count (PltC) values within normal range and markedly increased D-dimer and fibrinogen levels. Viscoelastic tests showed a maximum clot strength just above normal reference value, while fibrin clot strength was strongly increased. The overall contribution of fibrin to clot strength was high with 71 [56-85]%.

CONCLUSION: Anti Xa activity was within the target range of pharmacodynamic endpoint for covid-19 patients but viscoelastic tests still demonstrated a procoagulant pattern.

Original language	English
Pages (from-to)	1-3
Number of pages	3
Journal	Thrombosis Research
Volume	196
DOIs	https://doi.org/10.1016/j.thromres.2020.07.035
Publication status	Published - Dec 2020
Externally published	Yes

Keywords

Anti Xa activity
Covid-19
Thrombosis prophylaxis management
Viscoelastic coagulation tests

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10.1016/j.thromres.2020.07.035

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@article{e6687a7ca9404ff4a50aee2c46ee1ea1,

title = "Anti Xa activity after high dose LMWH thrombosis prophylaxis in covid 19 patients at the intensive care unit",

abstract = "INTRODUCTION: Coagulopathy in Coronavirus disease 2019 (covid-19) has been demonstrated by an increase in D-dimer, prothrombin time (PT), fibrinogen and factor VIII. Venous thromboembolic events are a common abnormality in patients with covid-19. We evaluate the results of intensive care unit (ICU) thrombosis prophylaxis of 5700 international unit (IU) nadroparin low molecular weight heparin (LMWH) twice daily.METHODS: After introduction of this high-dose pharmacological thrombosis prophylaxis twice weekly anti-factor Xa (anti Xa) concentrations and results from routine laboratory and viscoelastic hemostatic tests in 16 ICU covid-19 patients were evaluated.RESULTS: During one week, median peak anti Xa activities were 0.38 [0.16-0.45] and 0.38 [0.20-0.58] at time point 1 and 2 respectively. Laboratory coagulation tests showed PT, AT and platelet count (PltC) values within normal range and markedly increased D-dimer and fibrinogen levels. Viscoelastic tests showed a maximum clot strength just above normal reference value, while fibrin clot strength was strongly increased. The overall contribution of fibrin to clot strength was high with 71 [56-85]%.CONCLUSION: Anti Xa activity was within the target range of pharmacodynamic endpoint for covid-19 patients but viscoelastic tests still demonstrated a procoagulant pattern.",

keywords = "Anti Xa activity, Covid-19, Thrombosis prophylaxis management, Viscoelastic coagulation tests",

author = "Vlot, {E A} and {Van den Dool}, {E J} and Hackeng, {C M} and M Sohne and Noordzij, {P G} and {Van Dongen}, {E P A}",

note = "Publisher Copyright: {\textcopyright} 2020",

year = "2020",

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doi = "10.1016/j.thromres.2020.07.035",

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T1 - Anti Xa activity after high dose LMWH thrombosis prophylaxis in covid 19 patients at the intensive care unit

AU - Vlot, E A

AU - Van den Dool, E J

AU - Hackeng, C M

AU - Sohne, M

AU - Noordzij, P G

AU - Van Dongen, E P A

PY - 2020/12

Y1 - 2020/12

N2 - INTRODUCTION: Coagulopathy in Coronavirus disease 2019 (covid-19) has been demonstrated by an increase in D-dimer, prothrombin time (PT), fibrinogen and factor VIII. Venous thromboembolic events are a common abnormality in patients with covid-19. We evaluate the results of intensive care unit (ICU) thrombosis prophylaxis of 5700 international unit (IU) nadroparin low molecular weight heparin (LMWH) twice daily.METHODS: After introduction of this high-dose pharmacological thrombosis prophylaxis twice weekly anti-factor Xa (anti Xa) concentrations and results from routine laboratory and viscoelastic hemostatic tests in 16 ICU covid-19 patients were evaluated.RESULTS: During one week, median peak anti Xa activities were 0.38 [0.16-0.45] and 0.38 [0.20-0.58] at time point 1 and 2 respectively. Laboratory coagulation tests showed PT, AT and platelet count (PltC) values within normal range and markedly increased D-dimer and fibrinogen levels. Viscoelastic tests showed a maximum clot strength just above normal reference value, while fibrin clot strength was strongly increased. The overall contribution of fibrin to clot strength was high with 71 [56-85]%.CONCLUSION: Anti Xa activity was within the target range of pharmacodynamic endpoint for covid-19 patients but viscoelastic tests still demonstrated a procoagulant pattern.

AB - INTRODUCTION: Coagulopathy in Coronavirus disease 2019 (covid-19) has been demonstrated by an increase in D-dimer, prothrombin time (PT), fibrinogen and factor VIII. Venous thromboembolic events are a common abnormality in patients with covid-19. We evaluate the results of intensive care unit (ICU) thrombosis prophylaxis of 5700 international unit (IU) nadroparin low molecular weight heparin (LMWH) twice daily.METHODS: After introduction of this high-dose pharmacological thrombosis prophylaxis twice weekly anti-factor Xa (anti Xa) concentrations and results from routine laboratory and viscoelastic hemostatic tests in 16 ICU covid-19 patients were evaluated.RESULTS: During one week, median peak anti Xa activities were 0.38 [0.16-0.45] and 0.38 [0.20-0.58] at time point 1 and 2 respectively. Laboratory coagulation tests showed PT, AT and platelet count (PltC) values within normal range and markedly increased D-dimer and fibrinogen levels. Viscoelastic tests showed a maximum clot strength just above normal reference value, while fibrin clot strength was strongly increased. The overall contribution of fibrin to clot strength was high with 71 [56-85]%.CONCLUSION: Anti Xa activity was within the target range of pharmacodynamic endpoint for covid-19 patients but viscoelastic tests still demonstrated a procoagulant pattern.

KW - Anti Xa activity

KW - Covid-19

KW - Thrombosis prophylaxis management

KW - Viscoelastic coagulation tests

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DO - 10.1016/j.thromres.2020.07.035

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JO - Thrombosis Research

JF - Thrombosis Research

ER -

Anti Xa activity after high dose LMWH thrombosis prophylaxis in covid 19 patients at the intensive care unit

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