Anest. intenziv. Med. 2024;35(4):215-222 | DOI: 10.36290/aim.2024.032

Enoxaparin dosage and incidence of venous thromboembolism in critically ill patients with COVID-19Original Article

Beneš J.^{1, 2}, Kalina M.^{1, 3, 4}, Černý V.^4-9

¹ Lékařská fakulta v Hradci Králové, Univerzita Karlova, Hradec Králové

² Fakultní nemocnice Bulovka, Praha

³ Oddělení anesteziologie a intenzivní medicíny, Nemocnice Děčín, Krajská zdravotní

⁴ Fakulta zdravotnických studií, Univerzita J. E. Purkyně v Ústí nad Labem

⁵ Národní institut kvality a excelence zdravotnictví, Ústav zdravotnických informací a statistiky, Praha

⁶ Klinika anesteziologie a resuscitace, Fakultní nemocnice Královské Vinohrady, Univerzita Karlova v Praze, 3. LF UK, Praha

⁷ Klinika anesteziologie, resuscitace a intenzivní medicíny, Univerzita Karlova v Praze, Lékařská fakulta v Hradci Králové

⁸ Dept. of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Canada

⁹ Ústav klinických oborů a biomedicíny, Technická univerzita Liberec

Objective: COVID-19 is associated with a high risk of thromboembolic disease (VTE) and this risk is further increased in critically ill patients. Elevated D-dimer levels are a predictor of severe COVID-19 disease. Data on the incidence of VTE, mortality of critically ill patients with COVID-19, and its association with the dose of prophylactic anticoagulation in Czechia have not been published. We performed a retrospective analysis of patients with COVID-19 admitted to the intensive care unit. The primary endpoint was new-onset deep vein thrombosis during ICU stay. Secondary objectives were incidence of pulmonary embolism, venous thromboembolism (deep vein thrombosis and/or pulmonary embolism), number of episodes of major bleeding, ICU length of stay, ICU lethality, 28-day, 90-day, and 180-day lethality, and duration of artificial pulmonary ventilation.

Design: retrospective observational study. Setting: Intensive care units of a large general hospital.

Material and methods: We performed a retrospective analysis of medical records of patients hospitalized for COVID-19 in 4 intensive care units of a large general hospital between September 2020 and April 2021. Patients meeting the following inclusion criteria were included for analysis: age at least 18 years, principal diagnosis of COVID-19, length of stay in the ICU at least 72 hours, and absence of VTE on ICU admission.

Results: A total of 44 cases (13.3%) of new-onset VTE were identified. A total of 9 patients were diagnosed with pulmonary embolism, 31 patients with deep vein thrombosis, and 4 patients with deep vein thrombosis concomitant with pulmonary embolism. 274 patients received a standard prophylactic dose of enoxaparin, and 56 patients received intermediate or therapeutic doses. ICU, 28-day, 90-day, and 180-day mortality rates were 27%, 32%, 44%, and 47%, respectively. Mortality was not significantly associated with anticoagulant dose. There was a significant association between D-dimer levels and mortality.

Conclusion: The incidence of VTE found in a cohort of critically ill patients with COVID-19 was high. Elevated D-dimer levels were associated with 30-day, 90-day, and 180-day mortality. Increased dosing of low-molecular-weight heparin was not associated with a lower incidence of thromboembolism or lower mortality and cannot be recommended.

Keywords: covid-19, deep vein thrombosis, pulmonary embolism, D­‑dimer, anticoagulant, mortality.

Received: April 23, 2024; Revised: June 29, 2024; Accepted: July 26, 2024; Prepublished online: November 5, 2024; Published: December 17, 2024  Show citation