ANTIcoagulation in Severe COVID-19 Patients

Inclusion criteria

• Age ≥ 18 years ;
• Severe COVID-19 pneumonia, defined by:

• A newly-appeared pulmonary parenchymal infiltrate; AND
• a positive RT-PCR (either upper or lower respiratory tract) for COVID-19 (SARS-CoV-2); AND
• WHO progression scale ≥ 5 (on The Who ordinal scale)
• Written informed consent (patient, next of skin or emergency situation).
• In view of the exceptional and urgent situation, affiliation to a social security scheme will not be a criterion for inclusion.

Exclusion criteria

• Pregnancy and breast feeding woman;
• Postpartum (6 weeks);
• Extreme weights (<40 kg or >100 kg);
• Patients admitted since more than 72 hours to the hospital (if the WHO ordinal scale is 5 at time of inclusion) or since more than 72 hours to the intensive care unit (if the WHO ordinal scale is 6 or more at time of inclusion);
• Need for therapeutic anticoagulation (except for COVID-related pulmonary thrombosis);
• Bleeding event related to hemostasis disorders, acute clinically significant bleed, current gastrointestinal ulcer or any organic lesion with high risk for bleeding
• Platelet count < 50 G/L;
• Within 15 days of recent surgery, within 24 hours of spinal or epidural anesthesia;
• Any prior intracranial hemorrhage, enlarged acute ischemic stroke, known intracranial malformation or neoplasm, acute infectious endocarditis;
• Severe renal failure (creatinine clearance <30 mL/min);
• Iodine allergy;
• Hypersensitivity to heparin or its derivatives including low-molecular-weight heparin;
• History of type II heparin-induced thrombocytopenia;
• Chronic oxygen supplementation;
• Moribund patient or death expected from underlying disease during the current admission;
• Patient deprived of liberty and persons subject to institutional psychiatric care;
• Patients under guardianship or curatorship;
• Participation to another interventional research on anticoagulation.