Covid-19 and low molecular weight heparin therapy: retrospective study of 257 patients.

Abstract Objective To evaluate the role of low molecular weight heparin in COVID-19 treatment.Design Retrospective cohort studySetting Patients with COVID-19 pneumonia consecutively admitted to Castel San Giovanni COVID- Hospital from February 29, to April 7, 2020.Main outcome measure Hospital mortality and safety in patients treated with low molecular weight hep- arin.Results Of the 257 patients enrolled, 49 (19.1%) died during the hospitalization. Hospital mortality was significantly lower in patients treated with therapeutic dose of low molecular weight heparin (T-LMWH) (17/126, 13.5%), compared with patients treated with prophylactic dose (P-LMWH) (32/131, 24.4%; χ²=4.98, p = 0.02). Crude and adjusted odds ratios of mortality for patients treated with T-LMWH were OR=0.483, 95% CI 0.252-0.923 and OR=0.374, 95% CI 0.177-0.792. In a stratified analysis by ventila- tion type, the only subgroup of patients who benefited from therapeutic doses of heparin were those re- ceiving non-invasive mechanical ventilation (OR=0.099, 95% CI 0.028-0.354, p<0.001). No fatal bleed- ings were observed.Conclusion Treatment with therapeutic doses of T-LMWH is safe and seems to reduce mortality in COVID-19 patients with pneumonia, especially among those who need non-invasive mechanical ventila- tion. We look forward to prospective studies to confirm this observation and evaluate the appropriate dose of LMWH in the treatment of COVID-19 patients.

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Covid-19 and low molecular weight heparin therapy: retrospective study of 257 patients.

10.21203/rs.3.rs-57730/v2 ◽

2020 ◽

Author(s):

Marco Stabile ◽

Daniela Aschieri ◽

Cristina Maestri ◽

Luca Rosato ◽

Paola Novara ◽

...

Keyword(s):

Molecular Weight ◽

Mechanical Ventilation ◽

Retrospective Study ◽

Hospital Mortality ◽

Low Molecular Weight Heparin ◽

Heparin Therapy ◽

Low Molecular Weight ◽

Noninvasive Mechanical Ventilation ◽

Therapeutic Doses ◽

Stratified Analysis

Abstract A hypercoagulability state with fatal thrombosis events seems to characterize the clinical worsening of COVID-19 pneumonia. The benefit and safety of anticoagulant doses of low molecular weight heparin (LMWH) in COVID-19 are still unknown. We evaluated in a retrospective cohort study 257 COVID-19 patients consecutively admitted to our COVID-Hospital from February 29, to April 7, 2020. We compared the in-hospital mortality between patients treated with prophylactic or therapeutic doses of LMWH. Of the 257 patients enrolled, 49 (19.1%) died during the hospitalization. Hospital mortality was significantly lower in patients treated with therapeutic doses of LMWH (enoxaparin 70-100 I.U./kg twice daily) (17/126, 13.5%), than in patients treated with prophylactic doses (60-90 I.U./kg once daily) (32/131, 24.4%; χ²=4.98, p = 0.02). In a stratified analysis by ventilation type, the only subgroup of patients who benefited from therapeutic LMWH was that requiring noninvasive mechanical ventilation (OR=0.099, 95% CI 0.028-0.354, p<0.001). No fatal bleedings were observed. In this retrospective study the treatment with therapeutic LMWH is safe and seems to reduce mortality in COVID-19 patients, especially among those who need noninvasive mechanical ventilation. Authors Daniela Aschieri and Marco Stabile contributed equally to this work.

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Potential benefits of anticoagulant doses of low molecular weight heparin in COVID-19: An observational retrospective study

Emergency Care Journal ◽

10.4081/ecj.2021.9795 ◽

2021 ◽

Vol 17 (3) ◽

Author(s):

Daniela Aschieri ◽

Marco Stabile ◽

Cristina Maestri ◽

Luca Rosato ◽

Michela Giovanna Coccia ◽

...

Keyword(s):

Molecular Weight ◽

Low Molecular Weight Heparin ◽

Invasive Mechanical Ventilation ◽

Multivariate Logistic Regression Model ◽

Low Molecular Weight ◽

Care Community ◽

Kaplan Meier ◽

Fatal Bleeding ◽

The Difference ◽

Stratified Analysis

Hypercoagulability is a common complication of the systemic inflammation related to coronavirus disease 2019 creating debate within the critical care community on the therapeutic utility of Low Molecular Weight Heparin (LMWH). We collected data on consecutive patients with COVID-19 admitted to the Emergency Department of Castel San Giovanni Hospital, between February 29th and April 7th, 2020. Exclusion criteria were age <18 years, hospital stay <7 days, patients on dialysis and patients who had been transferred to other centers for which we could not collect data. Of the 257 patients included in the study, 49 (19.1%) died during hospitalization. We considered a wide set of variables as independent variables (age, sex, comorbidities and in-hospital treatments). We used a multivariate logistic regression model and, being heparin the only one therapy affecting survival rate, we compared prophylactic LMWH (p-LMWH) and Therapeutic LMWH (T-LMWH) groups. Kaplan Meier curve showed a higher survival probability in the T-LMWH and the difference between the two groups was statistically significant according to the log-rank or Mantel- Haenszel test (p< 0.0001). In a stratified analysis by ventilation type, the subgroup of patients who benefited from therapeutic LMWH was that in non-invasive mechanical ventilation. Using a multivariate analysis and adjusting for the drugs intake, TLMWH was the only therapy impacting on survival (HR 0.293, p <0.001). No fatal bleeding was observed. Therapeutic dose of LMWH in patients admitted to hospital with COVID-19 pneumonia was 70 associated with a decrease risk of intra-hospital mortality.

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