We appreciate the opportunity to respond to the letter from Dr Greenstein. It's true that most of the heparin users just received a prophylaxis dose in our study, due to lack of evidence of arterial or venous thromboembolism (VTE), and typical signs of disseminated intravascular coagulation (DIC) in the majority of the patients; in addition, some of them were also too unstable to transport for imaging examinations. Therapeutic doses of heparin had been used in patients with definite thrombosis but were not specifically mentioned in our paper.
According to a recent report about VTE prophylaxis in the management of COVID‐19, 1 40% of the patients were considered at high risk of VTE on the basis of the Padua Prediction Score 2 in a Chinese cohort with COVID‐19; however, only 7% of all patients received anticoagulant drugs during hospitalization. In a previous Chinese multicenter study, 3 36.6% of medical patients and 53.4% of surgical patients had a high risk of VTE during hospitalization, and only 6.0% and 11.8% of them, respectively, received an appropriate prophylactic. We have to say that routine thromboprophylaxis has not been routinely practiced in China.
Even so, our study has highlighted the importance of appropriate anticoagulant treatment for COVID‐19 patients with coagulopathy. Close monitoring of coagulation markers and early intervention are critical. Further prospective studies are required to elucidate whether higher doses of anticoagulants will provide more benefits in COVID‐19 patients with coagulopathy.
CONFLICTS OF INTEREST
None declared.
Manuscript Handled by: David Lillicrap
Final decision: David Lillicrap, 17 April 2020
REFERENCES
- 1. Wang T, Chen R, Liu C, et al. Attention should be paid to venous thromboembolism prophylaxis in the management of COVID‐19. Lancet Haematol. 2020;S2352‐3026(20)30109‐5. [published online ahead of print, 2020 Apr 9]. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Barbar S, Noventa F, Rossetto V, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost. 2010;8(11):2450‐2457. [DOI] [PubMed] [Google Scholar]
- 3. Zhai Z, Kan Q, Li W, et al. VTE risk profiles and prophylaxis in medical and surgical inpatients: the identification of Chinese hospitalized patients' risk profile for venous thromboembolism (DissolVE‐2)‐a cross‐sectional study. Chest. 2019;155(1):114‐122. [DOI] [PubMed] [Google Scholar]