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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Vydané v:Journal of thrombosis and haemostasis Ročník 18; číslo 5; s. 1094 - 1099
Hlavní autori: Tang, Ning, Bai, Huan, Chen, Xing, Gong, Jiale, Li, Dengju, Sun, Ziyong
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: England Elsevier Limited 01.05.2020
International Society on Thrombosis and Haemostasis. Published by Elsevier Inc
Predmet:
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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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.
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:1538-7933
1538-7836
1538-7836
DOI:10.1111/jth.14817