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Background <p>Effective thromboprophylaxis is critical to reducing mortality and improving clinical outcomes in COVID-19 patients. Despite guidelines recommending prophylactic anticoagulation, particularly for those in intensive care, real-world adherence and optimal venous thromboembolism (VTE) prevention strategies remain challenging, particularly in populations with complex comorbidities.</p> Methods <p>A prospective study was conducted on patients hospitalized with moderate, severe, and critical COVID-19 in six Chinese hospitals during the Omicron pandemic (December 2022-January 2023). The dose and duration of low-molecular-weight heparin (LMWH) were recorded. VTE, all-cause mortality and major bleeding events during hospitalization and 90-days follow-up were analyzed as endpoints.</p> Results <p>Among 4,236 COVID-19 patients, 1575 (37.09%) received LMWH prophylaxis, with 592 (37.6%) receiving reduced dosage (&lt; 4000IU/24&#xa0;h). The multivariable logistic regression model revealed that age ≥ 65, elevated D-dimer levels, severely ill at admission and concomitant use of antiviral drugs or corticosteroids were the main factors influencing the initiation of LMWH thromboprophylaxis in hospitalized COVID-19 patients. Patients who were critically ill at admission were more likely to receive reduced doses of LMWH. The duration of thromboprophylaxis over 7 days was associated with reduced estimated glomerular filtration rate (eGFR) and concomitant use of antiviral drugs or corticosteroid, whereas shorter durations were observed in patients with platelet less than 100*10<sup>9</sup>/L and anemia.</p> Conclusion <p>Real-world thromboprophylaxis in hospitalized COVID-19 patients vary widely, with a significant proportion receiving lower-than-conventional doses of LMWH. There is a need for individualized thromboprophylaxis strategies that consider patient-specific factors such as disease severity, renal function, low platelet and anemia to optimize outcomes.</p>

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Real-world practices of low-molecular-weight heparin for venous thromboembolism prophylaxis in patients hospitalized with COVID-19: a multicenter prospective study from China

  • 期刊论文

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  • 发表日期：

    2025年6月20日

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  • Feiya Xu,
  • Yuzhi Tao,
  • Lijun Chen,
  • Yunhui Zhang,
  • Binliang Wang,
  • Jing Han,
  • Chaosheng Deng,
  • Weijia Liu,
  • Guohui Fan,
  • Rui Liang,
  • Zhaofei Chen,
  • Yinong Chen,
  • Kaiyuan Zhen,
  • Yunxia Zhang,
  • Zhu Zhang,
  • Shuai Zhang,
  • Jun Wan,
  • Wanmu Xie,
  • Peiran Yang,
  • YuTing Kang,
  • Dingyi Wang,
  • Chen Wang,
  • Zhenguo Zhai

摘要

Background

Effective thromboprophylaxis is critical to reducing mortality and improving clinical outcomes in COVID-19 patients. Despite guidelines recommending prophylactic anticoagulation, particularly for those in intensive care, real-world adherence and optimal venous thromboembolism (VTE) prevention strategies remain challenging, particularly in populations with complex comorbidities.

Methods

A prospective study was conducted on patients hospitalized with moderate, severe, and critical COVID-19 in six Chinese hospitals during the Omicron pandemic (December 2022-January 2023). The dose and duration of low-molecular-weight heparin (LMWH) were recorded. VTE, all-cause mortality and major bleeding events during hospitalization and 90-days follow-up were analyzed as endpoints.

Results

Among 4,236 COVID-19 patients, 1575 (37.09%) received LMWH prophylaxis, with 592 (37.6%) receiving reduced dosage (< 4000IU/24 h). The multivariable logistic regression model revealed that age ≥ 65, elevated D-dimer levels, severely ill at admission and concomitant use of antiviral drugs or corticosteroids were the main factors influencing the initiation of LMWH thromboprophylaxis in hospitalized COVID-19 patients. Patients who were critically ill at admission were more likely to receive reduced doses of LMWH. The duration of thromboprophylaxis over 7 days was associated with reduced estimated glomerular filtration rate (eGFR) and concomitant use of antiviral drugs or corticosteroid, whereas shorter durations were observed in patients with platelet less than 100*109/L and anemia.

Conclusion

Real-world thromboprophylaxis in hospitalized COVID-19 patients vary widely, with a significant proportion receiving lower-than-conventional doses of LMWH. There is a need for individualized thromboprophylaxis strategies that consider patient-specific factors such as disease severity, renal function, low platelet and anemia to optimize outcomes.