Dose Of Enoxaparin Research Articles

A fixed dose approach to thrombosis chemoprophylaxis may be inadequate in heavier critically ill patients

Objectives: Overweight patients are at greater risk of venous thromboembolism. We aimed to describe prescribing patterns of thrombosis chemoprophylaxis in critically ill patients weighing ≥ 100 kg and quantify the effectiveness of these regimens using the surrogate biomarker of plasma anti-Xa level. Design, setting and patients: A prospective single-centre cohort study was conducted over a 6-month period. Patients weighing ≥ 100 kg who were prescribed enoxaparin for chemoprophylaxis and expected to remain in the intensive care unit for > 48 hours were eligible. Anti-Xa levels were measured once a patient had received at least three consecutive doses of enoxaparin. Peak levels were measured 4-6 hours after the third dose and trough levels were measured before the fourth dose. Anti-Xa levels were compared with established target ranges for peak and trough anti-Xa levels (0.2-0.5 IU/mL and > 0.1 IU/mL, respectively). Results: Eighty-eight patients met the eligibility criteria, and anti-Xa levels for 42 patients were obtained. Fixed dose chemoprophylaxis approaches varied considerably, with 40 mg once daily (54/88 [61%]) and 40 mg twice daily (20/88 [23%]) being the most frequently prescribed regimens. No patient had a peak anti-Xa level > 0.5 IU/mL. When comparing 40 mg once daily versus twice daily, the once daily regimen had lower median trough levels (0.01 IU/mL [interquartile range (IQR), 0.00-0.04] v 0.09 IU/mL [IQR, 0.05-0.13]; P < 0.001) and greater proportions of patients with levels below the established range (< 0.1 IU/mL) (15/16 [95%] v 7/14 [50%]; P = 0.002) and levels that were undetectable (0.00 IU/mL) (8/16 [50%] v 1/14 [7%]; P = 0.01). Conclusions: At a single centre, thrombosis chemoprophylaxis prescribing patterns for heavier critically ill patients varied considerably. Current fixed dose approaches may be inadequate in this cohort.

Single-center Experience with Venous Thromboembolism Prophylaxis for Obese Burn Patients.

Burn injured patients are at high risk of thromboembolic complications. Morbid obesity further increases this risk. Our objective was to evaluate the efficacy of enoxaparin dosed 40 mg twice daily in achieving prophylactic plasma anti-Xa levels in obese burn patients. A retrospective chart review from November 2018 until September 2019 identified patients who were either ≥100 kg or had a body mass index ≥30 kg/m2 and initiated on enoxaparin 40 mg twice daily for venous thromboembolism prophylaxis. Patients were ≥18 yr of age and received ≥3 sequential doses of enoxaparin with appropriately timed peak plasma anti-Xa levels to monitor efficacy. One hundred forty-eight patients were screened with 43 patients included for analysis. Forty-two percent of the patients did not reach target peak plasma anti-Xa levels (0.2-0.5 IU/ml) on enoxaparin 40 mg twice daily. Patients who did not meet prophylactic target levels were more likely to be male (P < 0.05) and have an increased mean body weight (129 ± 24 kg vs 110 ± 16 kg, P < 0.05). Thirteen out of 18 patients received dosage adjustments with subsequent anti-Xa levels available for follow-up assessment, of which an additional six patients required further dosage adjustment to meet prophylactic goals. Current utilization of a fixed 40 mg twice daily regimen of enoxaparin for venous thromboembolism (VTE) is inadequate to meet target prophylactic peak plasma anti-Xa levels in the obese burn patient population. Dose adjusting enoxaparin to target anti-Xa levels to reduce VTE rates in obese burn patients should be further evaluated.

Utilization practices of low molecular weight heparin in pediatric patients with acquired and congenital heart disease

BackgroundEnoxaparin is a commonly used anticoagulant for treatment of thrombosis in pediatric patients. Its use in pediatric cardiac patients has not been well described. We sought to examine the utilization trends, dosing, and safety of enoxaparin in pediatric cardiac patients. MethodsRetrospective study of pediatric cardiac patients treated with enoxaparin from 2011 to 2018. Starting and final doses of enoxaparin, number of dose adjustments, and time to therapeutic anti-factor Xa level were compared between age groups utilizing the Kruskal Wallis test with the Dunn test for pairwise comparisons. ResultsSeventy-one patients were treated with 77 courses of enoxaparin. Most enoxaparin courses were started on patients aged >12 months (40%) and for arterial thrombosis (22 patients, 29%). The most common cardiac diagnosis was hypoplastic left heart syndrome (12 patients, 17%). The mean final dose of enoxaparin was significantly different when comparing patients 0–3-month, 3–12 month, and >12 months (2.1 ± 0.5 mg/kg vs. 1.5 ± 0.4 mg/kg vs. 1.2 ± 1.4 mg/kg, respectively; p < 0.02). Patients 0–3 months and 3–12 months had significantly higher final to initial enoxaparin dose differences than the >12-month age group (0.4 ± 0.4 mg/kg vs. 0.4 ± 0.4 mg/kg vs. 0.1 ± 0.3 mg/kg, respectively; p < 0.01). All age groups needed 2–2.5 days to reach therapeutic anti-Xa levels. Patients aged 0–3 months had significantly more dose changes compared to those >12 months (2.2 ± 1.6 vs. 1.4 ± 1.4, p = 0.02). Antiplatelet therapy was used in 74% of courses. Adverse events were rare and had no relationship to antiplatelet use. ConclusionsEnoxaparin is an effective and safe anticoagulant in pediatric cardiac patients. Initial enoxaparin dosing should be increased from current recommended doses in patients between 3 and 12 months of age to achieve more timely therapeutic anticoagulation.

A pilot feasibility and safety multicenter trial of administering weight adjusted FiXED dose of low molecular weight heparin (ENOXAPARIN) to neonates and children with thrombosis

Abstract Introduction: Enoxaparin is a commonly used low molecular weight heparin (LMWH) for the treatment of thrombosis in neonates and children that is monitored with anti-factor Xa (anti-Xa) levels. However, this therapeutic range of anti-Xa (0.5–1.0 u/ml) was extrapolated from adult studies. The burden of pain to neonates and children due to venipunctures and of resources to the health care system also warrants an evidence-based review to assess the utility of monitoring LMWH therapy with anti-Xa levels. Here we describe the FiXET trial. Methods/Design: This is a prospective pilot, feasibility and safety multicenter, randomized controlled trial to compare the approach of treating thrombosis in neonates and children under 18 years of age with enoxaparin using weight adjusted fixed dose to variable dose titrated to maintain a pre-determined anti-Xa range (0.5–1.0 u/mL). We plan to recruit 20 neonates and children over the study period, who will be randomized within their first week of anti-coagulation treatment. Key feasibility outcomes include screening/recruitment ratio, monthly recruitment rate, and completeness of data collection. We will also measure the safety outcome of bleeding as well as comment on efficacy of resolution of thrombosis as a secondary outcome. Discussion: The administration of weight adjusted fixed dose of enoxaparin without anti-Xa monitoring has the potential to reduce pain from multiple venipunctures in neonates and children as well as resources used in their already complex care. The results of the FiXET trial will set the framework for a larger multicenter randomized controlled trial to compare the efficacy of administering enoxaparin to neonates without monitoring to the current conventional approach of routine monitoring with anti-Xa levels. Trial registration: The trial is registered with clinicaltrials.gov as NCT02486666.

Enoxaparina en el tratamiento de la tromboembolia venosa: estudio observacional de práctica clínica habitual

IntroductionThere are various types of low molecular weight heparins with different dosages for the treatment of venous thromboembolism (VTE). Material and methodsMulticentre observational-retrospective study including patients with VTE treated with enoxaparin and followed for one year. Patients were divided into 2groups: hospital and outpatient. The objective of the study was to describe the use of 2enoxaparin dosages (150 IU/kg per day and 100 IU/kg per 12hours) in the treatment of VTE in the 2groups. ResultsA total of 896 patients were included: 44.5% initiated enoxaparin in hospital and 55.6% as outpatients. The hospital patients compared with outpatients were older (69.6 vs. 66.1 years), had a higher Charlson index (3.0 vs. 2.5), and more pulmonary embolism (63.1 vs. 5.8%), and antiplatelet agent (68.8 vs. 51.4%) and corticosteroid use (25.1 vs. 13.7%). The dosage was once a day in 78.3% and twice a day in 21.7% of patients, with no between-group differences. Mean treatment duration (84.7 vs. 59.1 days) was higher in the hospital patients. The percentage of patients in whom the dosage was modified (22.6 vs. 20.9%) was similar between groups. Patients with VTE and cancer were mostly outpatients and received enoxaparin once a day. ConclusionsThe once-a-day dosage was the most widely used in both hospital patients and outpatients. In one fifth of patients, the enoxaparin dosage was modified during follow up.

Enoxaparin Dose Requirements to Achieve Therapeutic Low-molecular-weight Heparin Anti-factor Xa Levels in Infants and Young Children.

Enoxaparin is commonly used to treat pediatric thrombosis. Several small retrospective studies have suggested that infants and young children require higher enoxaparin doses to achieve therapeutic anti-factor Xa levels compared with adults. This is a retrospective study of hospitalized children who received enoxaparin for the treatment of thrombosis at a free-standing children's hospital. The primary objective was to ascertain the enoxaparin dose required to achieve an anti-factor Xa level of 0.5 to 1.0 U/mL among 4 age groups in a large cohort of infants and young children between 60 days and 5 years of age. A total of 176 infants and children were evaluated. The majority of patients were less than 1 year of age (n=104). An inverse relationship between enoxaparin dose needed to achieve therapeutic anti-factor Xa levels and patient age was noted, particularly in the first year of life. Patients who were 60 days to less than 7 months at the time of enoxaparin initiation (n=73) required the highest mean dose among the age groups at 1.73 mg/kg subcutaneously every 12 hours (P<0.0001). Infants and young children require higher doses of enoxaparin to achieve therapeutic anti-factor Xa levels compared with adults.

Cancer-Associated Venous Thromboembolism Treatment With Anti-Xa Versus Weight-Based Enoxaparin: A Retrospective Evaluation of Safety and Efficacy.

Venous thromboembolism (VTE) is a complication of cancer, for which low-molecular-weight heparin (LMWH) remains the preferred anticoagulant. Enoxaparin is traditionally dosed using weight. In certain populations, monitoring anti-Xa levels for therapeutic effect provides pharmacokinetic guidance for dose adjustments. There is a paucity of data regarding anti-Xa-directed enoxaparin dosing for treatment of VTE in patients with cancer. This study aims to evaluate efficacy (recurrent VTE) and safety (major bleed) between enoxaparin anti-Xa-guided dose adjustments and weight-based dosing in patients with cancer-associated VTE. This single-center, retrospective cohort study examined patients treated with enoxaparin for cancer-associated VTE using data from electronic health records. There were 674 patients who met the inclusion criteria, with 283 receiving anti-Xa-directed dose adjustments. Recurrent VTE, major bleed, or all-cause death occurred in 102 of 283 patients (36%) in the anti-Xa cohort and 166 of 391 patients (42.5%) in the weight-based cohort (hazard ratio [HR] = 0.73; 95% CI = 0.57-0.93; P = 0.01). When death was removed from the composite end point, there was no significant difference between the cohorts in recurrent VTE or major bleed (HR = 1.18; P = 0.38). In the anti-Xa cohort, a total of 1584 anti-Xa peak levels were collected, with 1324 (83.6%) drawn correctly in relation to enoxaparin administration. Of those, 714 (53.9%) were within therapeutic range. Patients with cancer receiving anti-Xa-guided enoxaparin dose adjustments for initial VTE, compared with weight-based dosing, had no significant difference in the rate of recurrent VTE or major bleed.

Comparison of two escalated enoxaparin dosing regimens for venous thromboembolism prophylaxis in obese hospitalized patients.

Standard fixed-dose enoxaparin dosing regimens may not provide adequate prophylaxis against venous thromboembolism among obese hospitalized patients. While several escalated doses have been shown to result in more frequent attainment of target anti-factor Xa levels than standard doses, few studies compare escalated doses to each other. In this prospective, multi-center trial, enoxaparin 0.5mg/kg daily (weight-based dosing) and enoxaparin 40mg twice daily were compared to determine if either dose resulted in more frequent attainment of anti-factor Xa levels within the goal range of 0.2-0.5IU/mL. Eighty patients with a BMI ≥ 40kg/m2 were enrolled. There was no difference in the percent of patients achieving goal anti-factor Xa levels (72.5% vs. 70.0%, respectively; p = 0.72). Patients were more likely to attain anti-factor Xa levels below goal range than above. No bleeding or thrombotic events occurred. Either weight-based or twice-daily escalated enoxaparin dosing regimens appear effective at achieving target anti-factor Xa levels among hospitalized patients, and no safety events were noted. Future studies are needed to determine the clinical significance of this result.

Increasing dosages of low-molecular-weight heparin in hospitalized patients with Covid-19.

We conducted an observational cohort study in adult patients consecutively admitted for the respiratory illness Covid-19 to our hub hospital from March 9 to April 7, 2020. The high observed rate of venous thromboembolism prompted us to increase the prophylactic doses of enoxaparin from 40 mg daily up to 1 mg/kg twice daily in patients admitted to intensive care units (ICU), 0.7 mg/kg twice daily in high-intensity of care wards and 1 mg/kg daily in low-intensity of care wards. Patients on high enoxaparin doses were compared to those who received prophylaxis with the standard dosage. Efficacy endpoints were mortality, clinical deterioration, and the occurrence of venous thromboembolism, safety endpoint was the occurrence of major bleeding. Of 278 patients with Covid-19, 127 received prophylaxis with high enoxaparin doses and 151 with standard dosage. At 21 days, the incidence rate of death and clinical deterioration were lower in patients on higher doses than in those on the standard dosage (hazard ratio 0.39, 95% confidence interval 0.23–0.62), and the incidence of venous thromboembolism was also lower (hazard ratio 0.52, 95% confidence interval 0.26–1.05). Major bleeding occurred in four of 127 patients (3.1%) on the high enoxaparin dosage. In conclusion, in the cohort of patients with Covid-19 treated with high enoxaparin dosages we observed a 60% reduction of mortality and clinical deterioration and a 50% reduction of venous thromboembolism compared to standard dosage prophylaxis. However, 3% of patients on high enoxaparin dosages had non-fatal major bleeding.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11739-020-02585-9.

Standard Prophylactic Versus Intermediate Dose Enoxaparin in Adults with Severe COVID-19: A Multi-Center, Open-Label, Randomised Controlled Trial

Background: Coronavirus disease 2019 (COVID-19) is associated with coagulopathy but the optimal prophylactic anticoagulation therapy remains uncertain and may depend on COVID-19 severity.Methods: We conducted a multi-center, open-label, randomised controlled trial comparing standard prophylactic dose versus intermediate dose enoxaparin in adults who were hospitalized with COVID-19 and admitted to an intensive care unit (ICU) and/or had laboratory evidence of coagulopathy. Patients were randomly assigned in a 1:1 ratio to receive standard prophylactic dose enoxaparin or intermediate weight-adjusted dose enoxaparin. The primary outcome was all-cause mortality at 30 days. Secondary outcomes included arterial or venous thromboembolism and major bleeding.Findings: A total of 176 patients (99 males and 77 females) underwent randomisation. In the intention-to-treat population, all-cause mortality at 30 days was 15% for intermediate dose enoxaparin and 21% for standard prophylactic dose enoxaparin (P=0.31 by chi-square test). Unadjusted Cox proportional hazards modeling demonstrated similar mortality with intermediate and standard dose enoxaparin (hazard ratio, 0.67; 95% confidence interval, 0.33 to 1.37; P=0.28. Arterial or venous thrombosis occurred in 13% of patients assigned to intermediate dose enoxaparin and 9% of patients assigned to standard dose enoxaparin. Major bleeding occurred in only 2% of patients in each arm.Interpretation: In hospitalized adults with severe COVID-19, standard prophylactic dose and intermediate dose enoxaparin did not differ significantly in preventing death or thrombosis at 30 days.Trial Registration: The trial was registered with ClinicalTrials.gov (NCT04360824).Funding Statement: National Institutes of Health Clinical and Translational Science Award.Declaration of Interests: SRL has served as a paid consultant for Novo Nordisk, UniQure, and Argenx, all outside the scope of the submitted work. All other authors declare no competing interests. SRB has served as an editor or committee member for Wiley, Abbott, and Boston Scientific Corporation. All other authors declare no competing interests.Ethics Approval Statement: The trial protocol was approved by the local institutional review boards of the participating sites. Written informed consent was obtained from all patients or their legally authorized representatives.

Enoxaparin dose impacts blood cell phenotypes during mild SARS-CoV-2 infection: the observational single-center study.

Coronavirus disease 2019 (COVID-19) is associated with various hemostatic abnormalities requiring constant search for better delicate antithrombotic management in these high-risk patients. The choice and the optimal dose of anticoagulant is important, but unclear, especially for mild COVID-19. Enoxaparin has been tested in several COVID trials with mixed results regarding hard clinical outcomes including mortality. We analyzed clinical, laboratory data and changes in platelets, erythrocytes and leukocytes by scanning electron microscopy on admission and at hospital discharge in patients with confirmed COVID-19 treated with enoxaparin (n = 31) and matched healthy controls (n = 32) in a retrospective observational study. The data were triaged by enoxaparin dose comparing 40 mg/daily prophylactic enoxaparin dose (PED) with 80 mg/daily therapeutic (TED) regimens. All patients experienced mild disease, none required pulmonary support, and all survived. The impact of enoxaparin dose was prominent for platelets and erythrocytes, but less evident for leukocytes. PED was associated with significant platelet activation, diminished numbers of silent nonactive discoid cells, and increased number and size of platelet microaggregates with leukocyte involvement. In contrast, TED did not cause extra platelet activation, while circulating platelet microaggregates were smaller and lacking leukocytes in their construction. PED caused significant increase of erythrocyte-platelet aggregates formation, and numerically higher proportion of circulating echinocytes. TED was associated with significant decrease of rouleaux sludge formation compared to only some trend after PED. Changes in leukocytes were less dependent on enoxaparin dose. However, PED has been associated with enhanced aggregate formation in 7 out of 10 patients, while trap net formation has been decreased in 17 out of 21 TED patients. We conclude that over hospital stay TED was superior to PED in patients with mild COVID-19. The inability of PED to adequately protect major circulating blood cells is probably due to enhanced clearance or/and diminished bioavailability of enoxaparin during COVID. These retrospective observational small sample size data may be relevant to better understanding of the mixed results in controlled outcome-driven trials exploring optimal COVID-19 anticoagulant strategies.

Spontaneous bilateral pectoralis major hematoma secondary to therapeutic dose of enoxaparin in elderly Covid-19 patient

Type 1 respiratory failure secondary to ventilation-perfusion mismatch by micro-thrombus in the pulmonary vasculature and subsequent damage to the endothelial cells is by far the most typical presentation of Covid-19 pneumonia. Computed tomography pulmonary angiogram remains the investigation of choice to diagnose pulmonary embolism or micro-thrombi; however, it is not possible due to extreme hemodynamic instability or oxygen requirements in patients, making the transfer to the scanner a precarious affair. Therefore, clinicians worldwide use anticoagulant treatment doses based on clinical features, blood investigations, or echocardiography following local or national guidelines. In this report, we describe a case of bilateral pectoralis major hematoma due to treatment dose of enoxaparin in an elderly Covid-19 patient admitted in our ICU. This case report emphasises the need for extra precaution and vigilance while using treatment dose of anticoagulants for suspected pulmonary embolism in Covid-19 patients.

Assessment of anti-factor Xa activity in critically ill COVID-19 patients receiving three different anticoagulation regimens

Introduction:Critically ill COVID-19 patients are at increased risk of thrombosis with an enhanced risk of bleeding. We aimed to explore the role of anti-factor Xa levels in optimizing the high-intensity anticoagulation’s safety and efficacy and finding possible associations between D-dimer levels, cytokine storm markers, and COVID-19-induced coagulopathy or thrombophilia.Methods:Retrospective cohort study conducted on 69 critically ill COVID-19 patients who received three regimens of higher intensity anticoagulation.Results:Seventeen patients (24.6%) received high-dose enoxaparin prophylaxis, 29 patients (42%) received therapeutic doses of enoxaparin, and 23 patients (33.3%) were on therapeutic unfractionated heparin infusion. Fewer than one-third of the whole cohort (n = 22; 31.8%) achieved the target range of anti-factor Xa. The patients were divided into three subgroups based on anti-factor Xa target status within each anticoagulation regimen; when compared, the only association observed among them was for interleukin-6 levels, which were significantly higher in both the “above the expected range” and “below the expected range” groups compared with the “within the expected range” group (p = 0.009). Major bleeding episodes occurred in 14 (20.3%) patients and were non-significantly more frequent in the “below the expected anti-factor Xa range group” (p = 0.415). Seven patients (10.1%) developed thrombosis. The majority of patients had anti-factor Xa levels below the expected ranges (four patients, 57.1%).Conclusion:Conventional anti-factor Xa ranges may not be appropriate as a predictive surrogate for bleeding in critically ill COVID-19. The clinical decision to initiate therapeutic anticoagulation preemptively may be individualized according to thrombosis and bleeding risks. Cytokine storm markers, namely, interleukin-6, may play a role in COVID-19-induced coagulopathy or thrombophilia.

Visoke vrednosti D-dimera i akutna plućna embolija nakon otpusta iz bolnice kod mladih pacijenata sa KOVID-19 - serija slučajeva

Introduction: The coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with an inflammatory and prothrombotic state that increases the risk of thromboembolic events. High levels of D-dimer are associated with the severity of the disease and acute pulmonary embolism (PE) is the most common thrombotic complication. Material and methods: We analyzed a series of four cases of COVID-19 in young patients (under 45 years) who developed PE with a delay of two to four weeks after hospital discharge. Results: These patients had elevated D-dimer (at least 10 times the upper limit of normal) at the initial admission and at the time of the PE diagnostic, while other parameters which involved inflammation and coagulation (C-reactive protein - CRP; lactate dehydrogenase - LDH; fibrinogen; international normalized ratio - INR) were normal. There were no pre-existing risk factors for PE and all the patients were anticoagulated with prophylactic intermediate doses of enoxaparin. Conclusions: PE is a complication of the COVID-19 disease which may occur later, especially in young patients with no other risk factors for the condition. The highly elevated levels of D-dimer at COVID-19 admission seem to be associated with the post-discharge apparition of PE. This data suggests the role of extended anticoagulation in selected COVID-19 patients and warrants further investigations.

Four-quadrant transverse abdominis plane block: A relatively new frontier for postoperative analgesia after major abdominal surgery

Four-quadrant transverse abdominis plane block: A relatively new frontier for postoperative analgesia after major abdominal surgery

Thromboprophylaxis causing spontaneous bleeds in COVID patients

COVID-19 is an ongoing pandemic that was identified in December 2019 in Wuhan, China. Patients admitted to the hospital with COVID-19 present with many coagulation abnormalities, precipitating a hypercoagulable state which exposes them to thrombosis for which they receive thromboprophylaxis therapy with enoxaparin. Over the course of this therapy, some patients develop spontaneous bleeding episodes in different regions of the body of varying degrees and sometimes require radiological angioembolisation to control the bleed. This case series sheds light on three patients who were admitted in Rashid Hospital, Dubai, UAE, with COVID-19 and developed spontaneous bleeds. Amongst the three patients, two of them developed retroperitoneal bleed and one patient developed a chest wall haematoma. One of them underwent radiological intervention (angioembolisation), while the other two underwent conservative management and were monitored for haemodynamic changes. There are limited studies demonstrating the correlation between high dose of enoxaparin and bleeding episodes amongst COVID-19 patients. However, we advise the need for further guidelines and data to advocate the relation between enoxaparin and bleeding episodes.

INFLUENCE OF DIFFERENT THROMBOPROPHYLAXIS REGIMENS WITH ENOXAPARIN ON THE COURSE AND OUTCOMES IN PATIENTS WITH SEVERE CORONAVIRUS DISEASE

Disorders of the hemostasis system play one of the key roles in the mechanism of pathogenesis of coronavirus disease. The prevalence of thromboembolic complications in patients with severe COVID-19 reaches 20–30%. Key guidelines provide guidance on the need for prophylactic doses of enoxaparin. However, the results of intensive care remain unsatisfactory and the search for the optimal dosing regimen of enoxaparin continues. The aim of the study was to compare the effect of different regimens of enoxaparin on the results of intensive care in patients with acute respiratory distress syndrome (ARDS) caused by SARS-nCoV.Materials and methods. A single-center prospective comparative study was conducted, which for the period May-October 2020 included 91 patients with severe coronavirus disease with the development of bilateral pneumonia and ARDS. Depending on the dosage regimen of enoxaparin, patients were divided into three groups. Patients of group 1 (n = 14) received 4000 anti-Xa MO of enoxaparin per day, group 2 (n = 20) – 8000-1200 anti-Xa MO, group 3 (n = 57) – 1600–2000 anti-Xa MO / days. Statistical analysis of the results was performed using the program «Statistica 10». Estimated median, minimum and maximum values, standard deviation. Significance of differences in indicators was assessed using the nonparametric Wilcoxon test. The results were considered reliable at values of p &lt;0.05. Data are presented as M ± SD [min-max]. The relative risk (RR) and the odds ratio (OR) of adverse events (thromboembolic complications and mortality) were assessed.Results. In group 1, 9 episodes of pulmonary embolism were recorded, which corresponds to 64.3%, in group 2 – 7 episodes (35.0%), and in group 3 – 13 (22.4%), (p13 = 0.04 ). The overall mortality rate was 69.23% and was significantly lower in group 3 – 56.9% than in group 1 – 92.9%, and group 2 – 85.0%.Conclusions. The use of therapeutic doses of enoxaparin is one of the key areas of therapy and has a positive effect on outcomes in patients with coronavirus disease, reducing the incidence of thromboembolic complications.

Clinical Characteristics Associated With Higher Enoxaparin Dosing Requirements for Venous Thromboembolism Prophylaxis in Trauma Patients.

Enoxaparin dosed by an anti-Xa trough level is effective at reducing venous thromboembolism (VTE) in trauma patients. We identified the patient characteristics associated with higher enoxaparin dosing based on anti-Xa trough levels. A retrospective review was conducted on trauma patients admitted between August 2014 and February 2018 who received enoxaparin dosed by the anti-Xa trough level. Patients who received enoxaparin < 50mg every 12hours were compared to those who required ≥ 50mg every 12hours. Of the 246 patients included, 32 (13.0%) required enoxaparin ≥ 50mg every 12hours to achieve the prophylactic trough level. Factors associated with a higher dose of enoxaparin were male (96.8% vs. 3.2%, P < .01), younger age (39.5 vs. 52.7years, P < .01), higher creatinine clearance (CrCl) (125.9 vs. 93.7mL/min, P < .01), higher body surface area (2m2 vs. 1.8m2, P < .01), and higher injury severity score (18.4 vs. 10.8, P < .01). Height, weight, and body mass index were not significant factors. On regression analysis, CrCl was the only independent predictor for higher enoxaparin dose. There was an increased deep venous thrombosis rate in the higher dose cohort (12.5% vs. 0, P < .01) but no significant differences in transfusion rates. Trauma patients who require higher enoxaparin doses to achieve prophylactic anti-Xa trough levels have a higher CrCl. Patients with high CrCl may benefit from an initial higher dose of enoxaparin to achieve a target anti-Xa level in a shorter time interval to decrease VTE risk.

Clinical Outcomes With the Use of Prophylactic Versus Therapeutic Anticoagulation in Coronavirus Disease 2019.

Objectives:To determine the impact of anticoagulation on inhospital mortality among coronavirus disease 2019-positive patients with the a priori hypothesis that there would be a lower risk of inhospital mortality with use of preemptive therapeutic over prophylactic dose enoxaparin or heparin.Design Setting:Retrospective cohort study from April 1, 2020, to April 25, 2020. The date of final follow-up was June 12, 2020 Two large, acute-care hospitals in Western Connecticut.Patients:Five hundred and one inpatients were identified after discharge as 18 years or older and positive for severe acute respiratory syndrome coronavirus 2. The final sample size included 374 patients after applying exclusion criteria. Demographic variables were collected via hospital billing inquiries, whereas the clinical variables were abstracted from patients’ medical records.Exposure:Preemptive enoxaparin or heparin at a therapeutic or prophylactic dose.Main Results:When comparing treatments through multivariable analysis, risk of inhospital mortality was 2.3 times greater in patients receiving preemptive therapeutic anticoagulation (95% CI = 1.0–4.9; p = 0.04). Additionally, the average treatment effects were higher (β = 0.11, p = 0.01) in the therapeutic group.Conclusions:An increase in inhospital mortality was observed among patients on preemptive therapeutic anticoagulation. Thus, in the management of coronavirus disease 2019 and its complications, we recommend further research and cautious use of preemptive therapeutic over prophylactic anticoagulation.

PCV58 Cost Analysis of Low-Molecular-Weight Heparins for the Treatment of Venous Thromboembolism in Spain

The aim of this study was to assess the treatment cost of tinzaparin, enoxaparin (brand and biosimilar) and bemiparin for the prevention of recurrence of venous thromboembolism (VTE) in Spain. The cost analysis model was built to estimate the initial treatment (15 days) for all patients and over a 180-day period in the secondary prevention of VTE in patients with active cancer. Specific dosage was based on each Summary of Product Characteristics. We selected data of RIETE registry to calculate the weights of different doses of enoxaparin. Drug prices were ex-factory (01/2020) + VAT (4%) + Royal Decree law 08/2010. Robustness were checked by a one-way sensitivity analysis considering patient weights. Daily cost was 10.48€ for tinzaparin, 11.24€ for biosimilar enoxaparin, 11.84€ for enoxaparin and 15.21€ for bemiparin. Tinzaparin showed a cheaper initial treatment cost with reduction between 7% (biosimilar enoxaparin) and 31% (bemiparin). In the long-term, total average cost treatment was 1.577€ for tinzaparin, 2.050€ for biosimilar enoxaparin, 2.161€ for enoxaparin and 2.408 for bemiparin. Independently of patients’ weight (40kg-100kg), tinzaparin was cheaper for all patient’s initial treatment and for the secondary prevention of VTE in patients with active cancer. The range of cost-savings with tinzaparin was 12-49% vs enoxaparin, 12-40% vs biosimilar enoxaparin and 25-48% vs bemiparin. Tinzaparin is a cost-saving alternative versus the rest of low molecular weight heparins in the treatment of VTE in Spain. This savings was observed in the initial treatment of all patients with VTE as well as in the long-term treatment of cancer associated thrombosis.