BMC Infectious Diseases (Feb 2022)

“H” is not for hydroxychloroquine—“H” is for heparin: lack of efficacy of hydroxychloroquine and the role of heparin in COVID-19—preliminary data of a prospective and interventional study from Brazil

  • Renata de Oliveira Costa,
  • Joyce Santos Nascimento,
  • Cadiele Oliana Reichert,
  • Adriana Pedroso Augusto da Costa,
  • Maria Aparecida Pedrosa dos Santos,
  • Alberto Macedo Soares,
  • Carlos Eduardo Mendonça Tomé,
  • Ricardo Leite Hayden,
  • Cassiano Waldanski dos Santos,
  • Bruno Barreiro,
  • Amer Abdul Basset El-Khatib,
  • Luís Alberto de Pádua Covas Lage,
  • Juliana Pereira,
  • Mônica Mazzurana Benetti

DOI
https://doi.org/10.1186/s12879-022-07110-1
Journal volume & issue
Vol. 22, no. 1
pp. 1 – 10

Abstract

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Abstract Background COVID-19 pandemic is the major public health problem in the world actually. It’s associated with high morbidity and mortality. To date, no therapeutic measure has a curative potential. Hydroxychloroquine (HCQ) is a drug with immunomodulatory properties that has demonstrated antiviral efficacy in in vitro experiments, with conflicting results in in vivo studies. Methods A single-center, prospective and interventional study, that evaluates the impact on mortality of the HCQ use in 154 patients hospitalized with COVID-19 in a Brazilian public hospital. The study also aims to determine prognostic factors that predict mortality, ICU admission and endotracheal intubation in this population. Results 154 patients diagnosed with COVID-19 confirmed by RT-PCR and hospitalized were included. There was a male predominance (87/154, 56.5%), median age 60 years and 88% (136/154) had comorbidities. Among these, 76% (117/154) were admitted to the ICU and 29.2% (45/154) experienced EOT. The OMR was 51.3% (79/154). There was no difference in mortality between patients treated with HCQ (N = 95) and non-HCQ (N = 59) (44.1% × 55.8%, p = 0.758). In univariate analysis, age ≥ 60 years (HR 3.62, p < 0.001), need for mechanical ventilation (HR 2.17, p = 0.001), ≥ 2 comorbidities (HR 1.83, p = 0.049), SAH (HR: 1.56, p = 0.054) were predictors of mortality, as well as no use of prophylactic or therapeutic heparin (HR 3.60, p = 0.02). Multivariate analysis identified admission to the ICU (HR 8.98, p = 0.002) and advanced age (HR 3.37, p < 0.01) as independent predictors of mortality, although, use of heparin (HR 0.25, p = 0.001) was independently associated with a favorable outcome. Conclusion This study confirmed the absence of a benefit associated with the use of HCQ in Brazilian patients hospitalized with COVID-19. However, prophylactic or therapeutic heparin was an independent predictor for reducing mortality in this population.

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