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Low-molecular-weight heparin use in coronavirus disease 2019 is associated with curtailed viral persistence: a retrospective multicentre observational study.
Pereyra, David; Heber, Stefan; Schrottmaier, Waltraud C; Santol, Jonas; Pirabe, Anita; Schmuckenschlager, Anna; Kammerer, Kerstin; Ammon, Daphni; Sorz, Thomas; Fritsch, Fabian; Hayden, Hubert; Pawelka, Erich; Krüger, Philipp; Rumpf, Benedikt; Traugott, Marianna T; Glaser, Pia; Firbas, Christa; Schörgenhofer, Christian; Seitz, Tamara; Karolyi, Mario; Pabinger, Ingrid; Brostjan, Christine; Starlinger, Patrick; Weiss, Günter; Bellmann-Weiler, Rosa; Salzer, Helmut J F; Jilma, Bernd; Zoufaly, Alexander; Assinger, Alice.
  • Pereyra D; Department of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Schwarzspanierstraße 17, 1090 Vienna, Austria.
  • Heber S; Division of Visceral Surgery, Department of Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria.
  • Schrottmaier WC; Institute of Physiology, Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria.
  • Santol J; Department of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Schwarzspanierstraße 17, 1090 Vienna, Austria.
  • Pirabe A; Division of Visceral Surgery, Department of Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria.
  • Schmuckenschlager A; Department of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Schwarzspanierstraße 17, 1090 Vienna, Austria.
  • Kammerer K; Department of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Schwarzspanierstraße 17, 1090 Vienna, Austria.
  • Ammon D; Department of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Schwarzspanierstraße 17, 1090 Vienna, Austria.
  • Sorz T; Division of Visceral Surgery, Department of Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria.
  • Fritsch F; Division of Visceral Surgery, Department of Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria.
  • Hayden H; Division of Visceral Surgery, Department of Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria.
  • Pawelka E; Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria.
  • Krüger P; Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria.
  • Rumpf B; Department of Vascular Biology and Thrombosis Research, Center of Physiology and Pharmacology, Medical University of Vienna, Schwarzspanierstraße 17, 1090 Vienna, Austria.
  • Traugott MT; Division of Visceral Surgery, Department of Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria.
  • Glaser P; Division of Visceral Surgery, Department of Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria.
  • Firbas C; Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria.
  • Schörgenhofer C; Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria.
  • Seitz T; Department of Medicine I, Medical University of Vienna, General Hospital Vienna, Vienna, Austria.
  • Karolyi M; Department of Clinical Pharmacology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria.
  • Pabinger I; Department of Clinical Pharmacology, Medical University of Vienna, General Hospital Vienna, Vienna, Austria.
  • Brostjan C; Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria.
  • Starlinger P; Department of Medicine IV, Kaiser Franz Josef Hospital, Vienna, Austria.
  • Weiss G; Department of Medicine I, Medical University of Vienna, General Hospital Vienna, Vienna, Austria.
  • Bellmann-Weiler R; Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria.
  • Salzer HJF; Division of Visceral Surgery, Department of Surgery, Medical University of Vienna, General Hospital Vienna, Vienna, Austria.
  • Jilma B; Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria.
  • Zoufaly A; Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria.
  • Assinger A; Department of Pulmonology, Kepler University Hospital, Johannes Kepler University, Linz, Austria.
Cardiovasc Res ; 117(14): 2807-2820, 2021 12 17.
Article in English | MEDLINE | ID: covidwho-1596913
ABSTRACT

AIMS:

Anticoagulation was associated with improved survival of hospitalized coronavirus disease 2019 (COVID-19) patients in large-scale studies. Yet, the development of COVID-19-associated coagulopathy (CAC) and the mechanism responsible for improved survival of anticoagulated patients with COVID-19 remain largely elusive. This investigation aimed to explore the effects of anticoagulation and low-molecular-weight heparin (LMWH) in particular on patient outcome, CAC development, thromboinflammation, cell death, and viral persistence. METHODS AND

RESULTS:

Data of 586 hospitalized COVID-19 patients from three different regions of Austria were evaluated retrospectively. Of these, 419 (71.5%) patients received LMWH and 62 (10.5%) received non-vitamin-K oral anticoagulants (NOACs) during hospitalization. Plasma was collected at different time points in a subset of 106 patients in order to evaluate markers of thromboinflammation (H3Cit-DNA) and the cell death marker cell-free DNA (cfDNA). Use of LMWH was associated with improved survival upon multivariable Cox regression (hazard ratio = 0.561, 95% confidence interval 0.348-0.906). Interestingly, neither LMWH nor NOAC was associated with attenuation of D-dimer increase over time, or thromboinflammation. In contrast, anticoagulation was associated with a decrease in cfDNA during hospitalization, and curtailed viral persistence was observed in patients using LMWH leading to a 4-day reduction of virus positivity upon quantitative polymerase chain reaction [13 (interquartile range 6-24) vs. 9 (interquartile range 5-16) days, P = 0.009].

CONCLUSION:

Time courses of haemostatic and thromboinflammatory biomarkers were similar in patients with and without LMWH, indicating either no effects of LMWH on haemostasis or that LMWH reduced hypercoagulability to levels of patients without LMWH. Nonetheless, anticoagulation with LMWH was associated with reduced mortality, improved markers of cell death, and curtailed viral persistence, indicating potential beneficial effects of LMWH beyond haemostasis, which encourages use of LMWH in COVID-19 patients without contraindications.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Heparin, Low-Molecular-Weight / Thromboinflammation / COVID-19 Drug Treatment / Anticoagulants Type of study: Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Cardiovasc Res Year: 2021 Document Type: Article Affiliation country: Cvr

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Heparin, Low-Molecular-Weight / Thromboinflammation / COVID-19 Drug Treatment / Anticoagulants Type of study: Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Cardiovasc Res Year: 2021 Document Type: Article Affiliation country: Cvr