Thromboprophylaxis in hospitalized COVID-19 patients: the efficacy and safety of the approved hospital protocol

Kolanko, Emanuel; Senderek, Tomasz; Prokop-Staszecka, Anna; Kruk, Aleksandra; Broniatowska, Elzbieta; Konieczynska, Malgorzata; Kopinski, Piotr; Pudlo, Joanna; Undas, Anetta

INTRODUCTION: Prothrombotic coagulopathy in COVID-19 has led to a strong recommendation for thromboprophylaxis in all hospitalized patients, although there are large differences in the dosage regimens among hospitals and their outcomes remain uncertain. Objectives: To determine the incidence of thrombotic events and bleeding in patients with COVID-19 using the approved local thromboprophylaxis protocol. PATIENTS AND METHODS: In 350 consecutive patients (median age 67 years) with confirmed COVID-19, treated in designated wards at a single center in Krakow, Poland from October 10, 2020, to April 30, 2021, we adapted a self-developed pharmacological thromboprophylaxis protocol based on clinical and laboratory risk assessment of thrombosis. We recorded in-hospital venous and arterial thromboembolic events, major or clinically relevant bleeding, and deaths along with other complications related to heparin administration. RESULTS: Thromboprophylaxis with low-molecular-weight heparin was administered in 99.7% of patients, 57 (16 %) was treated in the intensive care unit. As many as 92% of patients followed the protocol for >85% of hospitalization time. Thromboembolic events occurred in 16 (4.4%) patients: venous thromboembolism (n=4, 1.1%), ischemic stroke (n=4, 1.1%), and myocardial infarction (n=8, 2.2%). Hemorrhagic complications were observed in 31 (9%) patients, including fatal bleeds (n=3, 0.9%). The overall mortality was 13.4%. The prophylactic, intermediate and therapeutic anticoagulation preventive strategies with heparin were not related to any of the outcomes. CONCLUSION: Thromboprophylaxis protocol approved in our institution was associated with a relatively low risk of thromboembolism and bleeding, which provides additional evidence supporting the adoption of institutional strategies to improve outcomes in hospitalized COVID-19 patients.