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Low molecular weight heparin is useful in adult COVID-19 inpatients. Experience during the first Spanish wave: observational study
Gonzalez-Porras, Jose Ramon; Belhassen-Garcia, Moncef; Lopez-Bernus, Amparo; Vaquero-Roncero, Luis Mario; Rodriguez, Beatriz; Carbonell, Cristina; Azibeiro, Raul; Hernandez-Sanchez, Alberto; Martin-Gonzalez, Jose Ignacio; Manrique, Juan Miguel; Alonso-Claudio, Gloria; Alvarez-Navia, Felipe; Madruga-Martin, Jose Ignacio; Macias-Casanova, Ronald Paul; García-Criado, Jorge; Lozano, Francisco; Moyano, Jose Carlos; Sanchez-Hernandez, Miguel Vicente; Sagredo-Meneses, Víctor; Borras, Rafael; Bastida, Jose María; Hernández-Pérez, Guillermo; Chamorro, Antonio Javier; Marcos, Miguel; Martin-Oterino, Jose Angel.
  • Gonzalez-Porras, Jose Ramon; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Hematology. Salamanca. ES
  • Belhassen-Garcia, Moncef; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Salamanca. ES
  • Lopez-Bernus, Amparo; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Internal Medicine. Salamanca. ES
  • Vaquero-Roncero, Luis Mario; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Anesthesiology and Reanimation. Salamanca. ES
  • Rodriguez, Beatriz; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Internal Medicine. Salamanca. ES
  • Carbonell, Cristina; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Internal Medicine. Salamanca. ES
  • Azibeiro, Raul; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Hematology. Salamanca. ES
  • Hernandez-Sanchez, Alberto; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Hematology. Salamanca. ES
  • Martin-Gonzalez, Jose Ignacio; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Internal Medicine. Salamanca. ES
  • Manrique, Juan Miguel; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Internal Medicine. Salamanca. ES
  • Alonso-Claudio, Gloria; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Internal Medicine. Salamanca. ES
  • Alvarez-Navia, Felipe; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Internal Medicine. Salamanca. ES
  • Madruga-Martin, Jose Ignacio; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Internal Medicine. Salamanca. ES
  • Macias-Casanova, Ronald Paul; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Internal Medicine. Salamanca. ES
  • García-Criado, Jorge; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Emergency. Salamanca. ES
  • Lozano, Francisco; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Angiology and Vascular Surgery. Salamanca. ES
  • Moyano, Jose Carlos; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Clinical Biochemistry. Salamanca. ES
  • Sanchez-Hernandez, Miguel Vicente; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Anesthesiology and Reanimation. Salamanca. ES
  • Sagredo-Meneses, Víctor; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Intensive Care Medicine. Salamanca. ES
  • Borras, Rafael; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Emergency. Salamanca. ES
  • Bastida, Jose María; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Hematology. Salamanca. ES
  • Hernández-Pérez, Guillermo; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Internal Medicine. Salamanca. ES
  • Chamorro, Antonio Javier; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Internal Medicine. Salamanca. ES
  • Marcos, Miguel; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Internal Medicine. Salamanca. ES
  • Martin-Oterino, Jose Angel; Universidad de Salamanca. Instituto de Investigación Biomédica de Salamanca (IBSAL). Department of Internal Medicine. Salamanca. ES
São Paulo med. j ; 140(1): 123-133, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1357464
ABSTRACT
ABSTRACT

BACKGROUND:

The intensity of the thromboprophylaxis needed as a potential factor for preventing inpatient mortality due to coronavirus disease-19 (COVID-19) remains unclear.

OBJECTIVE:

To explore the association between anticoagulation intensity and COVID-19 survival. DESIGN AND

SETTING:

Retrospective observational study in a tertiary-level hospital in Spain.

METHODS:

Low-molecular-weight heparin (LMWH) status was ascertained based on prescription at admission. To control for immortal time bias, anticoagulant use was analyzed as a time-dependent variable.

RESULTS:

690 patients were included (median age, 72 years). LMWH was administered to 615 patients, starting from hospital admission (89.1%). 410 (66.7%) received prophylactic-dose LMWH; 120 (19.5%), therapeutic-dose LMWH; and another 85 (13.8%) who presented respiratory failure, high D-dimer levels (> 3 mg/l) and non-worsening of inflammation markers received prophylaxis of intermediate-dose LMWH. The overall inpatient-mortality rate was 38.5%. The anticoagulant nonuser group presented higher mortality risk than each of the following groups any LMWH users (HR 2.1; 95% CI 1.40-3.15); the prophylactic-dose heparin group (HR 2.39; 95% CI, 1.57-3.64); and the users of heparin dose according to biomarkers (HR 6.52; 95% CI, 2.95-14.41). 3.4% of the patients experienced major hemorrhage. 2.8% of the patients developed an episode of thromboembolism.

CONCLUSIONS:

This observational study showed that LMWH administered at the time of admission was associated with lower mortality among unselected adult COVID-19 inpatients. The magnitude of the benefit may have been greatest for the intermediate-dose subgroup. Randomized controlled trials to assess the benefit of heparin within different therapeutic regimes for COVID-19 patients are required.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Venous Thromboembolism / COVID-19 Type of study: Controlled clinical trial / Observational study Limits: Adult / Aged / Humans Language: English Journal: São Paulo med. j Journal subject: Cirurgia Geral / Ciˆncia / Ginecologia / Medicine / Medicina Interna / Obstetr¡cia / Pediatria / Sa£de Mental / Sa£de P£blica Year: 2022 Type: Article Affiliation country: Spain Institution/Affiliation country: Universidad de Salamanca/ES

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Full text: Available Index: LILACS (Americas) Main subject: Venous Thromboembolism / COVID-19 Type of study: Controlled clinical trial / Observational study Limits: Adult / Aged / Humans Language: English Journal: São Paulo med. j Journal subject: Cirurgia Geral / Ciˆncia / Ginecologia / Medicine / Medicina Interna / Obstetr¡cia / Pediatria / Sa£de Mental / Sa£de P£blica Year: 2022 Type: Article Affiliation country: Spain Institution/Affiliation country: Universidad de Salamanca/ES