More on COVID-19 coagulopathy in Caucasian patients

We are grateful for the comments of Marrietta et al.1 and welcome the opportunity to provide further details on the coagulopathy observed in our patients with coronavirus disease 2019 (COVID‐19) infection.2 The weight‐adjusted low‐molecular‐weight heparin (LMWH) thromboprophylaxis used in the study is that routinely used for hospital in‐patients in our institution, consistent with national recommendations.3, 4 With respect to the cohort of patients with COVID‐19 enrolled in our study, it is important to highlight that 74% of patients received enoxaparin 40 mg (4000 iu) subcutaneously once daily. In 12% of patients, the dose of enoxaparin was reduced to 20 mg once daily due to a weight of < 50 kg (8%) or renal impairment (4%). In all, 11% of our cohort were already on extended‐duration therapeutic anticoagulation at time of presentation with COVID‐19 for a variety of reasons (including atrial fibrillation, mitral valve replacement, and cancer‐associated venous thromboembolism) and consequently were maintained on the same during their admissions. Finally, 2% of patients did not receive thromboprophylaxis due to perceived increased bleeding risks. Of particular importance in respect to the point raised by Marrietta et al.1, only one patient with COVID‐19 actually received an enoxaparin dose of > 40 mg for thromboprophylaxis (due to increased body weight of > 100 kg). In summary therefore, the doses of LWMH used in our cohort are entirely consistent with best practice guidelines. In addition, none of our cohort developed any major bleeding or clinically relevant non‐major bleeding complications.5, 6