Bemiparin Versus Enoxaparin for Extended Thromboprophylaxis in COVID-19 Patients at High Risk of Venous Thromboembolism

Abstract

Introduction: Patients with COVID-19 are at increased risk of thromboembolic events during hospitalization and after discharge. Current guidelines recommend use of extended thromboprophylaxis in hospitalized COVID-19 patients who have high risk of post-discharge venous thromboembolism and low risk of bleeding. We aimed to report our experience regarding different low-molecular-weight heparins administered post-discharge in a COVID-19 patient population with high-thromboembolic and low-bleeding risk. Methods: This was a single-center, retrospective, observational study. Consecutive patients admitted with a confirmed diagnosis of COVID-19 between March 16 and July 16, 2020, were assessed for enrollment. Patients were included if they received prophylaxis with low-molecular-weight heparins after discharge, were ≥18 years of age, and completed follow-up. Pregnant women, children <18 years of age, patients with intensive care unit admission, and patients who experienced venous and/or arterial thromboembolism prior to discharge were excluded. Extended thromboprophylaxis with either enoxaparin 4000 IU once daily or bemiparin 3500 IU once daily was prescribed if a patient had a modified IMPROVE VTE score of ≥4, or a modified IMPROVE score of ≥2 and a D-dimer level of ≥2 times the reference range. Patients were followed-up for 30 days after discharge. Primary endpoint was occurrence of radiologically confirmed symptomatic venous thromboembolism (deep vein thrombosis and/or pulmonary embolism). Results: A total of 3498 consecutive patients were hospitalized with a diagnosis of COVID-19. Of them, 38 (20 women) received extended thromboprophylaxis. Mean of age was 66.6±15.7 years. Twenty-five patients received enoxaparin, and 13 received bemiparin. Three patients in the enoxaparin group and none of the patients in the bemiparin group experienced post-discharge venous thromboembolism (p=0.681). Major bleeding occurred in one patient in the enoxaparin group, and in zero patients in the bemiparin group (p=0.456). Conclusion: Enoxaparin and bemiparin have similar prophylactic properties when used for prevention of post-discharge venous thromboembolism in COVID-19 survivors who have high thromboembolic and low bleeding risk.