Low molecular weight heparin is useful in adult COVID-19 inpatients. Experience during the first Spanish wave: observational study.
Sao Paulo Med J
; 140(1): 123-133, 2022.
Article
in English
| MEDLINE | ID: covidwho-1362119
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 ANDSETTING:
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.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Venous Thromboembolism
/
COVID-19
Type of study:
Experimental Studies
/
Observational study
/
Prognostic study
/
Randomized controlled trials
Limits:
Adult
/
Aged
/
Humans
Language:
English
Journal:
Sao Paulo Med J
Journal subject:
Medicine
Year:
2022
Document Type:
Article
Affiliation country:
1516-3180.2021.0098.R1.08062021
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