PMID- 32560658 OWN - NLM STAT- MEDLINE DCOM- 20200630 LR - 20240329 IS - 1466-609X (Electronic) IS - 1364-8535 (Print) IS - 1364-8535 (Linking) VI - 24 IP - 1 DP - 2020 Jun 19 TI - Prevention of thrombotic risk in hospitalized patients with COVID-19 and hemostasis monitoring. PG - 364 LID - 10.1186/s13054-020-03000-7 [doi] LID - 364 AB - COVID-19 is an infection induced by the SARS-CoV-2 coronavirus, and severe forms can lead to acute respiratory distress syndrome (ARDS) requiring intensive care unit (ICU) management. Severe forms are associated with coagulation changes, mainly characterized by an increase in D-dimer and fibrinogen levels, with a higher risk of thrombosis, particularly pulmonary embolism. The impact of obesity in severe COVID-19 has also been highlighted.In this context, standard doses of low molecular weight heparin (LMWH) may be inadequate in ICU patients, with obesity, major inflammation, and hypercoagulability. We therefore urgently developed proposals on the prevention of thromboembolism and monitoring of hemostasis in hospitalized patients with COVID-19.Four levels of thromboembolic risk were defined according to the severity of COVID-19 reflected by oxygen requirement and treatment, the body mass index, and other risk factors. Monitoring of hemostasis (including fibrinogen and D-dimer levels) every 48 h is proposed. Standard doses of LMWH (e.g., enoxaparin 4000 IU/24 h SC) are proposed in case of intermediate thrombotic risk (BMI < 30 kg/m(2), no other risk factors and no ARDS). In all obese patients (high thrombotic risk), adjusted prophylaxis with intermediate doses of LMWH (e.g., enoxaparin 4000 IU/12 h SC or 6000 IU/12 h SC if weight > 120 kg), or unfractionated heparin (UFH) if renal insufficiency (200 IU/kg/24 h, IV), is proposed. The thrombotic risk was defined as very high in obese patients with ARDS and added risk factors for thromboembolism, and also in case of extracorporeal membrane oxygenation (ECMO), unexplained catheter thrombosis, dialysis filter thrombosis, or marked inflammatory syndrome and/or hypercoagulability (e.g., fibrinogen > 8 g/l and/or D-dimers > 3 mug/ml). In ICU patients, it is sometimes difficult to confirm a diagnosis of thrombosis, and curative anticoagulant treatment may also be discussed on a probabilistic basis. In all these situations, therapeutic doses of LMWH, or UFH in case of renal insufficiency with monitoring of anti-Xa activity, are proposed.In conclusion, intensification of heparin treatment should be considered in the context of COVID-19 on the basis of clinical and biological criteria of severity, especially in severely ill ventilated patients, for whom the diagnosis of pulmonary embolism cannot be easily confirmed. FAU - Susen, Sophie AU - Susen S AUID- ORCID: 0000-0001-5953-163X AD - Department of Hematology and Transfusion, Lille University Hospital, Lille, France. Sophie.SUSEN@CHRU-LILLE.FR. AD - Department of Hemostasis and Transfusion, CHU Lille, Lille, France. Sophie.SUSEN@CHRU-LILLE.FR. FAU - Tacquard, Charles Ambroise AU - Tacquard CA AD - Department of Anesthesia and Intensive Care, Strasbourg University Hospital, Strasbourg, France. FAU - Godon, Alexandre AU - Godon A AD - Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, La Tronche, France. FAU - Mansour, Alexandre AU - Mansour A AD - Department of Anesthesiology and Critical Care Medicine, Rennes University Hospital, Rennes, France. FAU - Garrigue, Delphine AU - Garrigue D AD - Department of Hematology and Transfusion, Lille University Hospital, Lille, France. FAU - Nguyen, Philippe AU - Nguyen P AD - Department of Hematology Laboratory, Reims University Hospital, Reims, France. FAU - Godier, Anne AU - Godier A AD - Department of Anesthesia and Intensive Care, HEGP-AP-HP, Paris, France. FAU - Testa, Sophie AU - Testa S AD - AO Istituti Ospitalieri, Cremona, Italy. FAU - Levy, Jerrold H AU - Levy JH AD - Duke University Hospital, Durham, NC, USA. FAU - Albaladejo, Pierre AU - Albaladejo P AD - Department of Anesthesiology and Critical Care, Grenoble Alpes University Hospital, La Tronche, France. FAU - Gruel, Yves AU - Gruel Y AUID- ORCID: 0000-0002-1250-6063 AD - Department of Hematology-Hemostasis, Tours University Hospital, CHRU Tours, Tours, France. yves.gruel@univ-tours.fr. CN - GIHP and GFHT LA - eng PT - Journal Article PT - Review DEP - 20200619 PL - England TA - Crit Care JT - Critical care (London, England) JID - 9801902 SB - IM CIN - Crit Care. 2021 Mar 10;25(1):101. PMID: 33691711 MH - COVID-19 MH - Coronavirus Infections/physiopathology/*therapy MH - Hemostasis/*physiology MH - *Hospitalization MH - Humans MH - Monitoring, Physiologic MH - Pandemics MH - Pneumonia, Viral/physiopathology/*therapy MH - Risk MH - Thrombosis/*prevention & control PMC - PMC7303590 OTO - NOTNLM OT - Anticoagulant OT - COVID-19 OT - Coagulation OT - Heparin OT - Obesity OT - Thrombosis COIS- The authors declare that they have no competing interests. FIR - Albaladejo, P IR - Albaladejo P FIR - Blais, N IR - Blais N FIR - Bonhomme, F IR - Bonhomme F FIR - Borel-Derlon, A IR - Borel-Derlon A FIR - Cohen, A IR - Cohen A FIR - Collet, J-P IR - Collet JP FIR - de Maistre, E IR - de Maistre E FIR - Fontana, P IR - Fontana P FIR - Huet, D Garrigue IR - Huet DG FIR - Godier, A IR - Godier A FIR - Gruel, Y IR - Gruel Y FIR - Godon, A IR - Godon A FIR - Ickx, B IR - Ickx B FIR - Laporte, S IR - Laporte S FIR - Lasne, D IR - Lasne D FIR - Llau, J IR - Llau J FIR - Le Gal, G IR - Le Gal G FIR - Lecompte, T IR - Lecompte T FIR - Lessire, S IR - Lessire S FIR - Levy, J H IR - Levy JH FIR - Longrois, D IR - Longrois D FIR - Madi-Jebara, S IR - Madi-Jebara S FIR - Mansour, A IR - Mansour A FIR - Mazighi, M IR - Mazighi M FIR - Mismetti, P IR - Mismetti P FIR - Morange, P E IR - Morange PE FIR - Motte, S IR - Motte S FIR - Mullier, F IR - Mullier F FIR - Nathan, N IR - Nathan N FIR - Nguyen, P IR - Nguyen P FIR - Pernod, G IR - Pernod G FIR - Rosencher, N IR - Rosencher N FIR - Roullet, S IR - Roullet S FIR - Roy, P M IR - Roy PM FIR - Schlumberger, S IR - Schlumberger S FIR - Sie, P IR - Sie P FIR - Steib, A IR - Steib A FIR - Susen, S IR - Susen S FIR - Tacquard, C A IR - Tacquard CA FIR - Testa, S IR - Testa S FIR - Vincentelli, A IR - Vincentelli A FIR - Zufferey, P IR - Zufferey P FIR - Borel-Derlon, A IR - Borel-Derlon A FIR - Boissier, E IR - Boissier E FIR - Dumont, B IR - Dumont B FIR - de Maistre, E IR - de Maistre E FIR - Gruel, Y IR - Gruel Y FIR - James, C IR - James C FIR - Lasne, D IR - Lasne D FIR - Lecompte, T IR - Lecompte T FIR - Morange, P E IR - Morange PE FIR - Nguyen, P IR - Nguyen P FIR - Siguret, V IR - Siguret V FIR - Susen, S IR - Susen S EDAT- 2020/06/21 06:00 MHDA- 2020/07/01 06:00 PMCR- 2020/06/19 CRDT- 2020/06/21 06:00 PHST- 2020/04/24 00:00 [received] PHST- 2020/05/18 00:00 [accepted] PHST- 2020/06/21 06:00 [entrez] PHST- 2020/06/21 06:00 [pubmed] PHST- 2020/07/01 06:00 [medline] PHST- 2020/06/19 00:00 [pmc-release] AID - 10.1186/s13054-020-03000-7 [pii] AID - 3000 [pii] AID - 10.1186/s13054-020-03000-7 [doi] PST - epublish SO - Crit Care. 2020 Jun 19;24(1):364. doi: 10.1186/s13054-020-03000-7.