Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy

Background A relatively high mortality of severe coronavirus disease 2019 (COVID‐19) is worrying, and the application of heparin in COVID‐19 has been recommended by some expert consensus because of the risk of disseminated intravascular coagulation and venous thromboembolism. However, its efficacy r...

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Vydáno v:	Journal of thrombosis and haemostasis Ročník 18; číslo 5; s. 1094 - 1099
Hlavní autoři:	Tang, Ning, Bai, Huan, Chen, Xing, Gong, Jiale, Li, Dengju, Sun, Ziyong
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	England Elsevier Limited 01.05.2020 International Society on Thrombosis and Haemostasis. Published by Elsevier Inc
Témata:	Age Factors Aged Anticoagulants Anticoagulants - administration & dosage Anticoagulants - therapeutic use Betacoronavirus Biomarkers - blood Blood Coagulation Tests coagulopathy Coronaviridae coronavirus disease 2019 Coronavirus Infections - complications Coronavirus Infections - drug therapy Coronavirus Infections - mortality Coronaviruses COVID-19 Disseminated intravascular coagulation Disseminated Intravascular Coagulation - drug therapy Disseminated Intravascular Coagulation - etiology D‐dimer Female Fibrin Fibrinogen Degradation Products Health risk assessment Heparin Heparin, Low-Molecular-Weight - administration & dosage Heparin, Low-Molecular-Weight - therapeutic use Humans low molecular weight heparin Male Middle Aged Molecular weight Mortality Multivariate analysis Original Pandemics Patients Platelet Count Pneumonia, Viral - complications Pneumonia, Viral - drug therapy Pneumonia, Viral - mortality Prognosis Prothrombin Prothrombin Time Retrospective Studies SARS-CoV-2 Sepsis Survival Rate Thromboembolism D-dimer low molecular weight heparin coagulopathy coronavirus disease 2019 sepsis
ISSN:	1538-7933, 1538-7836, 1538-7836
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Popis
Shrnutí:	Background A relatively high mortality of severe coronavirus disease 2019 (COVID‐19) is worrying, and the application of heparin in COVID‐19 has been recommended by some expert consensus because of the risk of disseminated intravascular coagulation and venous thromboembolism. However, its efficacy remains to be validated. Methods Coagulation results, medications, and outcomes of consecutive patients being classified as having severe COVID‐19 in Tongji hospital were retrospectively analyzed. The 28‐day mortality between heparin users and nonusers were compared, as was a different risk of coagulopathy, which was stratified by the sepsis‐induced coagulopathy (SIC) score or D‐dimer result. Results There were 449 patients with severe COVID‐19 enrolled into the study, 99 of them received heparin (mainly with low molecular weight heparin) for 7 days or longer. D‐dimer, prothrombin time, and age were positively, and platelet count was negatively, correlated with 28‐day mortality in multivariate analysis. No difference in 28‐day mortality was found between heparin users and nonusers (30.3% vs 29.7%, P = .910). But the 28‐day mortality of heparin users was lower than nonusers in patients with SIC score ≥4 (40.0% vs 64.2%, P = .029), or D‐dimer >6‐fold of upper limit of normal (32.8% vs 52.4%, P = .017). Conclusions Anticoagulant therapy mainly with low molecular weight heparin appears to be associated with better prognosis in severe COVID‐19 patients meeting SIC criteria or with markedly elevated D‐dimer.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23
ISSN:	1538-7933 1538-7836 1538-7836
DOI:	10.1111/jth.14817