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

Abstract

Background:A relatively high mortality of severe coronavirus disease 2019 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. K E Y W O R D Scoagulopathy, coronavirus disease 2019, D-dimer, low molecular weight heparin, sepsis

SARS-CoV-2 in Spanish Intensive Care Units: Early experience with 15-day survival in Vitoria

“…The same authors also reported D-dimer above 1 ug/ml among 81% of non-survivors and our J o u r n a l P r e -p r o o f findings are consistent with these observations. Although no difference on overall 28-day mortality was found between heparin users and non-users (30.3% vs. 29.7%, p = 0.91) in a report among 449 patients with severe SARS-CoV-2 infection in China (14), the 28-day mortality was significantly reduced in those receiving low molecular weight heparin with a D-dimer > 6 fold the upper limit of normal (32% vs. 52%, p = 0.01) or a SIC score (15) > 4 (40% vs. 64%, p = 0.02).…”

COVID-19 Complicated by Acute Pulmonary Embolism and Right-Sided Heart Failure

“…[3] It is, however, estimated that about 50% of these patients have elevated ddimer levels during disease progression which is directly associated with the risk of increased thrombosis and poor prognosis of the disease. [2,5] Multivariable regression showed increased odds of in-hospital death associated with d-dimer greater than 1 μg/mL (18·42, 2·64-128·55; p=0·0033). [4] A higher risk of vessel thrombosis has been correlated with the severity of the disease and multiorgan involvement, leading support to the argument of therapeutic anticoagulation of COVID-19 patients with elevated d-dimer levels.…”

“…[4] A higher risk of vessel thrombosis has been correlated with the severity of the disease and multiorgan involvement, leading support to the argument of therapeutic anticoagulation of COVID-19 patients with elevated d-dimer levels. [5] The proposed mechanisms for COVID-19 induced thrombosis include a disease-specific hypercoagulable state, cytokine-mediated diffuse microvascular damage and in some cases reactive thrombocytosis. [6] The risk of thrombosis and pulmonary embolism can further be compounded by obesity, advanced age, and hospitalization related immobilization.…”

Recomendaciones sobre el tratamiento antitrombótico durante la pandemia COVID-19. Posicionamiento del Grupo de Trabajo de Trombosis Cardiovascular de la Sociedad Española de Cardiología

“…Con base en la relación bidireccional entre la inflamación y la trombosis o «inmunotrombosis», el bloqueo de la trombina por la HBPM puede amortiguar la respuesta inflamatoria 23 y reducir el daño endotelial 24 . Tang et al 25 , en un reciente estudio con 449 pacientes, observaron una reducción de la mortalidad con la HBPM en los pacientes que adquirían criterios de CID o elevación de dímero D > 6 veces el límite superior de la normalidad. Liny et al 26 observaron que los pacientes en que aumentaba el dímero D > 4 veces el límite superior de la normalidad con criterios de CID presentaban cambios isquémicos distales, por lo que proponían una pauta de HBPM de 100 UI/kg/12 h durante 5 días 26 .…”