.jpg "Veronica Bonderski, BCCCP, PharmD photo")
Veronica Bonderski, BCCCP, PharmD
Clinical Pharmacy Specialist, Neurosciences ICU
The University of Chicago Medicine
Chicago, Illinois
Disclosure information not submitted.
Joshua DeMott, MS, PharmD, BCPS, BCCCP
Clinical Pharmacy Specialist, Emergency Medicine
Rush University Medical Center, United States
Disclosure information not submitted.
William Whittier, MD
Professor, Department of Internal Medicine, Division of Nephrology
Rush University Medical Center, United States
Disclosure information not submitted.
Nicholas Panos, PharmD, BCPS, BCCCP
Clinical Pharmacy Specialist, Neuroscience Intensive Care
Rush University Medical Center, United States
Disclosure information not submitted.
Roger Rodby, MD
Professor, Department of Internal Medicine, Division of Nephrology
Rush University Medical Center, United States
Disclosure information not submitted.
Shivi Jain, MD
Assistant Professor, Department of Internal Medicine, Division of Hematology
Rush University Medical Center, United States
Disclosure information not submitted.
Casey Gashti, MD
Associate Professor, Department of Internal Medicine, Division of Nephrology
Rush University Medical Center, United States
Disclosure information not submitted.
.jpg "Payal Gurnani, PharmD, BCPS, BCCCP, photo")
Payal Gurnani, PharmD, BCPS, BCCCP,
Clinical Pharmacy Specialist, Cardiovascular ICU
Memorial Hermann - The Woodlands Medical Center
The Woodlands, Texas
Disclosure information not submitted.
Title: Precision Dosing and Safety of Enoxaparin in High Risk Patients with COVID-19
INTRODUCTION/HYPOTHESIS: Low molecular weight heparins have emerged as promising treatment options for patients with thrombotic complications associated with COVID-19. However, there is no available data on the use of therapeutic low molecular weight heparins to prevent thrombotic complications in patients with COVID-19 and comorbidities that require alternative dosing strategies. Therefore, the purpose of this study is to evaluate proposed enoxaparin dosing regimens, guided by anti-Xa monitoring, and safety of these regimens in COVID-19 patients with a documented venous thromboembolism, renal dysfunction, or morbid obesity.
Methods: This is a retrospective observational cohort study of patients identified from an institutional COVID-19 registry. High risk patients with documented venous thromboembolism, body mass index ≥ 50 kg/m2, acute kidney injury, or requiring renal replacement therapy receiving therapeutic enoxaparin and anti-Xa monitoring were included. Anti-Xa levels, enoxaparin dosing requirements, and bleeding events were collected.
Results: Of the 103 patients included, 55 patients had an initial supratherapeutic anti-Xa level on therapeutic enoxaparin. On the initial therapeutic enoxaparin regimen, 7% experienced major bleeding and 17% experienced non-major bleeding. Patients requiring renal replacement therapy had the highest rate of therapeutic anti-Xa levels and least amount of enoxaparin dosing variability. Overall, 38% of patients experienced new thrombosis while receiving therapeutic enoxaparin.
Conclusions: Therapeutic enoxaparin use in high risk patients with COVID-19 and a body mass index ≥ 50 kg/m2 or renal dysfunction resulted in a high rate of supratherapeutic anti-Xa levels and bleeding. Institutions should consider implementing a dosing and monitoring protocol for enoxaparin use in COVID-19.