Personalized prophylactic anticoagulation in hospitalized patients with Covid-19 – The role of anti-Xa monitoring

Due to the strong association between severe COVID-19 and a prothrombotic state, most experts suggest an intensified anticoagulation regimen, mostly including an intermediate dose of low-molecular heparin, even though there is no clear clinical evidence supporting the efficacy of this strategy. In our hospital, among 16 patients admitted due to COVID-19, initially treated with enoxaparin 40mg/daily, 81.3% needed dose adjustment due to lower than 0.4IU/ml anti-Xa levels. Based on this approach, a median enoxaparin dose of 60mg (IQR 50-80mg) once daily was needed to successfully tailor prophylaxis with an anti-Xa between 0.4-0.5IU/ml. A future randomized study comparing patients treated with prophylactic enoxaparin to patients treated with a tailored approach based on anti-Xa monitoring could be performed.