fondaparinux and Coronavirus-Infections

Many centres have noticed a high number of venous thromboembolism (VTE) events among critically ill inpatients with COVID-19 pneumonia. The aims of this study were (1) to summarise the reported risk of VTE associated with COVID-19 infections and (2) to summarise guidance documents on thromboprophylaxis in COVID-19 patients, in a systematic review.. We systematically searched for peer-reviewed evidence on the risk of VTE in patients with COVID-19, in PubMed, Embase and Twitter, and for guidelines or guidance documents for thromboprophylaxis, from international or national societies relevant to the field of thrombosis and haemostasis, up to April 30 2020.. We found 11 studies (1 clinical trial, 7 retrospective cohorts and 3 prospective cohorts), which included a range of 16 to 388 in patients with COVID-19 (total of 1369 inpatients). The diagnoses of COVID-19 and VTE were of high quality, but the follow-up was often unclear. Most studies reported universal in-hospital thromboprophylaxis. Among all inpatients and among intensive care unit (ICU) inpatients with COVID-19, reported risks of VTE were 4.4–8.2% (three studies) and 0–35.3% (six studies), respectively. Two studies at least partially screened for VTE in ICU inpatients with COVID-19, and found risks of 24.7–53.8%. We found 12 guidelines for thromboprophylaxis of COVID-19 patients. The majority suggested universal pharmacological thromboprophylaxis in all COVID-19 inpatients, but there was heterogeneity in the suggested intensity of thromboprophylaxis: seven advised considering intensified doses of heparin according to the clinical or biological severity of the disease, especially in the ICU setting.. Venous thromboembolism very commonly complicates the clinical course of inpatients with COVID-19, despite thromboprophylaxis. The risk appears highest among critically ill inpatients. We found no estimates of risks among outpatients. Many questions remain unresolved, as delineated by the heterogeneity of national and international guidelines. This situation calls for fast randomised clinical trials, comparing different schemes of thromboprophylaxis in COVID-19 inpatients.

Topics: Anticoagulants; Betacoronavirus; Coronavirus Infections; COVID-19; Fondaparinux; Heparin; Heparin, Low-Molecular-Weight; Humans; Pandemics; Pneumonia, Viral; Practice Guidelines as Topic; Pulmonary Embolism; Risk; SARS-CoV-2; Venous Thromboembolism; Venous Thrombosis

Topics: Anticoagulants; Betacoronavirus; Coronavirus Infections; COVID-19; Drug Administration Schedule; Fondaparinux; Heparin, Low-Molecular-Weight; Humans; Pandemics; Patient Discharge; Pneumonia, Viral; Risk Factors; SARS-CoV-2; Venous Thromboembolism

Topics: Acute Kidney Injury; Betacoronavirus; Coronavirus Infections; COVID-19; Disease Progression; Erythrocyte Transfusion; Factor Xa Inhibitors; Fibrin Fibrinogen Degradation Products; Fondaparinux; Hematuria; Hepatorenal Syndrome; Humans; Liver Cirrhosis; Male; Melena; Mesenteric Ischemia; Middle Aged; Pandemics; Platelet Transfusion; Pneumonia, Viral; Portal Vein; Purpura; SARS-CoV-2; Severity of Illness Index; Thrombotic Microangiopathies

Topics: Antibody Specificity; Anticoagulants; Autoantibodies; Betacoronavirus; Coronavirus Infections; COVID-19; Fondaparinux; Heparin; Heparin, Low-Molecular-Weight; Humans; Pandemics; Platelet Count; Platelet Factor 4; Pneumonia, Viral; Purpura, Thrombocytopenic, Idiopathic; SARS-CoV-2; Thrombophilia

Topics: Aged; Anticoagulants; Betacoronavirus; Coronavirus Infections; COVID-19; Enoxaparin; Female; Fondaparinux; Heparin; Humans; Male; Middle Aged; Pandemics; Pneumonia, Viral; Retrospective Studies; SARS-CoV-2; Treatment Outcome; Venous Thromboembolism

The use of heparin has been shown to decrease the mortality in hospitalized patients with severe COVID-19. The aim of our study was to evaluate the clinical impact of venous thromboembolism prophylaxis with fondaparinux versus enoxaparin among 100 hospitalized COVID-19 patients. The incidence of pulmonary embolism, deep venous thrombosis, major bleeding (MB), clinically relevant non-MB, acute respiratory distress syndrome, and in-hospital mortality was compared between patients on fondaparinux versus enoxaparin therapy. The 2 groups were homogeneous for demographic, laboratory, and clinical characteristics. In a median follow-up of 28 (IQR: 12-45) days, no statistically significant difference in venous thromboembolism (14.5% vs. 5.3%; P = 0.20), MB and clinically relevant non-MB (3.2% vs. 5.3%, P = 0.76), ARDS (17.7% vs. 15.8%; P = 0.83), and in-hospital mortality (9.7% vs. 10.5%; P = 0.97) has been shown between the enoxaparin group versus the fondaparinux group. Our preliminary results support the hypothesis of a safe and effective use of fondaparinux among patients with COVID-19 hospitalized in internal medicine units.

Topics: Aged; Anticoagulants; Antithrombins; Coronavirus Infections; COVID-19; Enoxaparin; Factor Xa Inhibitors; Female; Fondaparinux; Hemorrhage; Hospital Mortality; Humans; Incidence; Male; Middle Aged; Pandemics; Pneumonia, Viral; Pulmonary Embolism; Retrospective Studies; Venous Thromboembolism; Venous Thrombosis