Real-world practices of low-molecular-weight heparin for venous thromboembolism prophylaxis in patients hospitalized with COVID-19: a multicenter prospective study from China

Feiya Xu; Yuzhi Tao; Lijun Chen; Yunhui Zhang; Binliang Wang; Jing Han; Chaosheng Deng; Weijia Liu; Guohui Fan; Rui Liang; Zhaofei Chen; Yinong Chen; Kaiyuan Zhen; Yunxia Zhang; Zhu Zhang; Shuai Zhang; Jun Wan; Wanmu Xie; Peiran Yang; YuTing Kang; Dingyi Wang; Chen Wang; Zhenguo Zhai

doi:10.1186/s12959-025-00741-9

Real-world practices of low-molecular-weight heparin for venous thromboembolism prophylaxis in patients hospitalized with COVID-19: a multicenter prospective study from China

Thromb J. 2025 Jun 20;23(1):69. doi: 10.1186/s12959-025-00741-9.

Authors

Feiya Xu^#¹, Yuzhi Tao^#^{2

3}, Lijun Chen^#⁴, Yunhui Zhang^#⁵, Binliang Wang^#⁶, Jing Han⁷, Chaosheng Deng⁸, Weijia Liu⁷, Guohui Fan³, Rui Liang⁹, Zhaofei Chen^{3

10}, Yinong Chen^{3

10}, Kaiyuan Zhen^{3

10}, Yunxia Zhang³, Zhu Zhang³, Shuai Zhang³, Jun Wan¹¹, Wanmu Xie³, Peiran Yang¹², YuTing Kang¹³, Dingyi Wang¹⁴, Chen Wang^{15

16}, Zhenguo Zhai¹⁷

Affiliations

¹ Institute of Clinical Medical Sciences), China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, China.
² The First Bethune Hospital of Jilin University, Jilin University, Changchun, 130021, China.
³ National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, China.
⁴ Department of Pulmonary and Critical Care Medicine, The First People's Hospital of Yinchuan, Yinchuan, 750001, China.
⁵ Department of Pulmonary and Critical Care Medicine, First People's Hospital of Yunnan Province, Yunnan, 650034, China.
⁶ Department of Pulmonary and Critical Care Medicine, Taizhou First People's Hospital, Taizhou, 318020, China.
⁷ Department of Pulmonary and Critical Care Medicine, Guizhou Provincial People's Hospital, Guiyang, 550000, China.
⁸ Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, China.
⁹ Beijing University of Chinese Medicine China-Japan Friendship School of Clinical Medicine, Beijing, 100105, China.
¹⁰ Peking University China-Japan Friendship School of Clinical Medicine, Beijing, 10029, China.
¹¹ Department of Pulmonary and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
¹² Department of Physiology, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, School of Basic Medicine Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100005, China.
¹³ Department of Science Research, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
¹⁴ National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, China. wg_snake@163.com.
¹⁵ Institute of Clinical Medical Sciences), China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, China. cyh-birm@263.net.
¹⁶ National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, China. cyh-birm@263.net.
¹⁷ National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, China. zhaizhenguo2011@126.com.

^# Contributed equally.

Abstract

Background: Effective thromboprophylaxis is critical to reducing mortality and improving clinical outcomes in COVID-19 patients. Despite guidelines recommending prophylactic anticoagulation, particularly for those in intensive care, real-world adherence and optimal venous thromboembolism (VTE) prevention strategies remain challenging, particularly in populations with complex comorbidities.

Methods: A prospective study was conducted on patients hospitalized with moderate, severe, and critical COVID-19 in six Chinese hospitals during the Omicron pandemic (December 2022-January 2023). The dose and duration of low-molecular-weight heparin (LMWH) were recorded. VTE, all-cause mortality and major bleeding events during hospitalization and 90-days follow-up were analyzed as endpoints.

Results: Among 4,236 COVID-19 patients, 1575 (37.09%) received LMWH prophylaxis, with 592 (37.6%) receiving reduced dosage (< 4000IU/24 h). The multivariable logistic regression model revealed that age ≥ 65, elevated D-dimer levels, severely ill at admission and concomitant use of antiviral drugs or corticosteroids were the main factors influencing the initiation of LMWH thromboprophylaxis in hospitalized COVID-19 patients. Patients who were critically ill at admission were more likely to receive reduced doses of LMWH. The duration of thromboprophylaxis over 7 days was associated with reduced estimated glomerular filtration rate (eGFR) and concomitant use of antiviral drugs or corticosteroid, whereas shorter durations were observed in patients with platelet less than 100*10⁹/L and anemia.

Conclusion: Real-world thromboprophylaxis in hospitalized COVID-19 patients vary widely, with a significant proportion receiving lower-than-conventional doses of LMWH. There is a need for individualized thromboprophylaxis strategies that consider patient-specific factors such as disease severity, renal function, low platelet and anemia to optimize outcomes.

Keywords: COVID-19; Low-molecular-weight heparin; Thromboprophylaxis; Venous thromboembolism.

Abstract

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