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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 JR; MD, PhD. Physician, Department of Hematology, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Belhassen-Garcia M; MD, PhD. Physician, Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Lopez-Bernus A; MD, PhD. Physician, Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Vaquero-Roncero LM; MD, PhD. Physician, Department of Anesthesiology and Reanimation, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Rodriguez B; MD. Physician, Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Carbonell C; MD, PhD. Physician, Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Azibeiro R; MD. Physician, Department of Hematology, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Hernandez-Sanchez A; MD. Physician, Department of Hematology, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Martin-Gonzalez JI; MD, PhD. Physician, Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Manrique JM; MD. Physician, Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Alonso-Claudio G; MD. Physician, Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Alvarez-Navia F; MD. Physician, Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Madruga-Martin JI; MD, PhD. Physician, Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Macias-Casanova RP; MD. Physician, Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • García-Criado J; MD. Physician, Department of Emergency, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Lozano F; MD, PhD. Physician, Department of Angiology and Vascular Surgery, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Moyano JC; MD, PhD. Physician, Department of Clinical Biochemistry, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Sanchez-Hernandez MV; MD. Physician, Department of Anesthesiology and Reanimation, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Sagredo-Meneses V; MD. Physician, Department of Intensive Care Medicine, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Borras R; MD. Physician, Department of Emergency, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Bastida JM; MD, PhD. Physician, Department of Hematology, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Hernández-Pérez G; MD. Physician, Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Chamorro AJ; MD, PhD. Physician, Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Marcos M; MD, PhD. Physician, Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
  • Martin-Oterino JA; MD, PhD. Physician, Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
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 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 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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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