Risk Benefit Analysis in Reference to use of LMWH in COVID-19

• Published in: Journal of the Association of Physicians of India Vol. 68; no. 9; pp. 52 - 61
• Main Authors: Samajdar, Shambo Samrat, Sam, Priya Ann, Moitra, Saibal, Ray, Yogiraj, Pal, Jyotirmoy, Joshi, Shashank R, Tripathi, Santanu K
• Format: Journal Article
• Language: English
• Published: India 01.09.2020
• Subjects: Anticoagulants - therapeutic use; Betacoronavirus; Coronavirus Infections; COVID-19; Heparin, Low-Molecular-Weight - therapeutic use; Humans; Pandemics; Pneumonia, Viral; Risk Factors; SARS-CoV-2
• ISSN: 0004-5772

Venous thromboembolism (VTE) and disseminated intravascular coagulation (DIC) are frequent cardiovascular and/or respiratory complications among hospitalized patients of COVID-19 infection. A relatively high mortality of severe coronavirus disease 2019 (COVID-19) is worrying, and the application of heparin in COVID-19 has been assessed and recommended with some expert consensus because of the risk of DIC and venous thromboembolism. However, "Risk Benefit Analysis" on the aspect of safety in using low molecular weight heparin (LMWH) in COVID-19 patients for thrombosis prophylaxis has been explained below with a few case studies and detailed information from various clinical evidence. COVID-19 infection has been associated with inflammation and a prothrombotic state, with increase in fibrin, fibrin degradation products, fibrinogen, and D-dimers. Heparin treatment including unfractionated and low molecular weight heparin appears to be associated with better prognosis in severe COVID-19 patients with coagulopathy. Major studies since the onset of this pandemic, found better prognosis in severe COVID-19 patients meeting SIC criteria or with markedly elevated D-dimer, by approaching thrombosis prophylaxis with LMWH.