Treatment of Long COVID With Enoxaparin

Background and Purpose: Long COVID is a complex multisystemic disease state, which represents a huge economic and health burden worldwide. Hypercoagulation and the formation of fibrinaloid microclots have been proposed as an underlying pathology, which may underpin a wide variety of presenting symptoms, via reduced blood flow and cellular energy production. Postexertional malaise (PEM) is common and exercise therapy should not be recommended without addressing the underlying pathology. Case Presentation: Patient was female, 43, with Long COVID for 21 months characterized primarily by extreme fatigue, exercise intolerance, PEM, cognitive dysfunction, and postural orthostatic tachycardia syndrome. She was unable to work or leave the house unless for essential medical appointments. Before her initial severe acute respiratory syndrome coronavirus 2 infection, she had no prior health conditions or comorbidities, a body mass index of 20.8, and engaged in regular vigorous exercise. Intervention: This case report describes a patient treated with enoxaparin, a low molecular weight heparin, at 20 mg per day subcutaneously, with assessment at 8 weeks. Outcomes: The patient's function and quality of life improved markedly, as reported subjectively, and with objective measurements at 8 weeks. Levels of activity improved markedly with no adverse events. The severity of PEM decreased dramatically, and postural orthostatic tachycardia syndrome was better controlled. The FUNCAP score, used to measure functional capacity, increased from 3.3 (moderately affected) to 5.07 (mildly affected) after treatment. Discussion: It is recommended that this treatment should be further investigated to elucidate the role of enoxaparin in addressing underlying pathology in Long COVID, including hypercoagulation and microclots.