São Paulo Medical Journal ()

Low molecular weight heparin is useful in adult COVID-19 inpatients. Experience during the first Spanish wave: observational study

  • Jose Ramon Gonzalez-Porras,
  • Moncef Belhassen-Garcia,
  • Amparo Lopez-Bernus,
  • Luis Mario Vaquero-Roncero,
  • Beatriz Rodriguez,
  • Cristina Carbonell,
  • Raul Azibeiro,
  • Alberto Hernandez-Sanchez,
  • Jose Ignacio Martin-Gonzalez,
  • Juan Miguel Manrique,
  • Gloria Alonso-Claudio,
  • Felipe Alvarez-Navia,
  • Jose Ignacio Madruga-Martin,
  • Ronald Paul Macias-Casanova,
  • Jorge García-Criado,
  • Francisco Lozano,
  • Jose Carlos Moyano,
  • Miguel Vicente Sanchez-Hernandez,
  • Víctor Sagredo-Meneses,
  • Rafael Borras,
  • Jose María Bastida,
  • Guillermo Hernández-Pérez,
  • Antonio Javier Chamorro,
  • Miguel Marcos,
  • Jose Angel Martin-Oterino

DOI
https://doi.org/10.1590/1516-3180.2021.0098.r1.08062021

Abstract

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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.

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