Pulmonary Embolism or Pulmonary Thrombosis in COVID-19? Is the Recommendation to Use High-Dose Heparin for Thromboprophylaxis Justified?

Acutely ill medical patients are at heightened risk for venous thromboembolism, a term that combines deep vein thrombosis (DVT) and its more severe complication, pulmonary embolism.[1] [2] Although the incidence of venous thromboembolism in medical patients might have been overestimated in some instances, according to a recent study,[3] treatment by low, prophylactic doses of low molecular weight heparin (LMWH) is recommended for these patients when additional risk factors coexist.[1] [2] COVID-19 is an acute, complex disorder that is associated with SARS-CoV-2 infection, which, in its most severe presentation, is characterized by the development of interstitial pneumonia and acute respiratory distress syndrome.[4] According to many reports, COVID-19 exposes patients to a particularly high risk for venous thromboembolism.[5] [6] [7] [8] Hence, hospitalized COVID-19 patients are generally treated with higher LMWH doses than recommended for thromboprophylaxis. A recent document by the Italian Drug Agency (AIFA) suggested the use of 80 to 100 mg enoxaparin daily, instead of the usual 40 mg, while in some hospitals, even higher, up to full anticoagulant doses of LMWH or unfractionated heparin[9] are used. In our hospital we use 40 mg enoxaparin daily, as recommended for high-risk, acutely ill medical patients.[1] [2]