Thromboprophylaxis for Patients in ICU With COVID-19

Many reports have postulated a procoagulant state along with the respiratory distress caused
by coronavirus SARS-CoV2. A complex physiopathology has been proposed trying to explain this
profile, mainly based on the thromboinflammatory concept, with thrombosis at both venous and
arterial levels. Microvascular thrombi impair the blood flow all over the body, with a
vascular shunt due to capillary obstruction, that determines hypoxia and tissue dysfunction
at several organs, being the lung the more affected one.

Although D-Dimers (DD) are not specific indicators of clot formation, its elevation, in
combination with other parameters (hyperfibrinogenemia, mild thrombocytopenia) may suggest a
systemic coagulation activation with an increase of thrombin generation and fibrinolysis. In
fact, in a retrospective Chinese analysis, a DD higher than 1000 ng/ml was proposed to
identify patients with poor prognosis at an early stage.

Nevertheless, knowledge on how to prevent or even treat this procoagulant state is scarce.
Thromboprophylaxis with low molecular-weight heparin (LMWH) is recommended in most medical
patients admitted to the hospital and in nearly all patients in an Intensive Care Unit (ICU).
But COVID-19 patients may be out of these recommendations, and some treatment schemes has
been proposed, although how to decide the suitable LMWH for each clinical situation is
controversial. Recent retrospective studies suggest a better prognosis in severe COVID-19
patients receiving anticoagulant therapy with LMWH. However, the LMWH efficacy and safety,
mainly in COVID-19 patients admitted to the ICU, remains to be validated.