Low in-hospital mortality rate in patients with COVID-19 receiving thromboprophylaxis: data from the multicentre observational START-COVID Register

Abstract

COVID-19 infection causes respiratory pathology with severe interstitial pneumonia and extra-pulmonary complications; in particular, it may predispose to thromboembolic disease. The current guidelines recommend the use of thromboprophylaxis in patients with COVID-19, however, the optimal heparin dosage treatment is not well-established. We conducted a multicentre, Italian, retrospective, observational study on COVID-19 patients admitted to ordinary wards, to describe clinical characteristic of patients at admission, bleeding and thrombotic events occurring during hospital stay. The strategies used for thromboprophylaxis and its role on patient outcome were, also, described. 1091 patients hospitalized were included in the START-COVID-19 Register. During hospital stay, 769 (70.7%) patients were treated with antithrombotic drugs: low molecular weight heparin (the great majority enoxaparin), fondaparinux, or unfractioned heparin. These patients were more frequently affected by comorbidities, such as hypertension, atrial fibrillation, previous thromboembolism, neurological disease, and cancer with respect to patients who did not receive thromboprophylaxis. During hospital stay, 1.2% patients had a major bleeding event. All patients were treated with antithrombotic drugs; 5.4%, had venous thromboembolism [30.5% deep vein thrombosis (DVT), 66.1% pulmonary embolism (PE), and 3.4% patients had DVT + PE]. In our cohort the mortality rate was 18.3%. Heparin use was independently associated with survival in patients aged ≥ 59 years at multivariable analysis. We confirmed the high mortality rate of COVID-19 in hospitalized patients in ordinary wards. Treatment with antithrombotic drugs is significantly associated with a reduction of mortality rates especially in patients older than 59 years.

Predictors of venous thromboembolism in COVID-19 patients: results of the COVID-19 Brazilian Registry

“…In those patients, pulmonary embolism (PE) represents a major diagnostic challenge, as its symptoms and signs overlap with the ones of the severe acute respiratory syndrome (SARS). The occurrence of VTE in patients with COVID-19 has been shown to increase mortality [ 14 – 17 ] and thromboprophylaxis appears to reduce mortality in those patients [ 18 ]. Therefore, there has been a major worldwide effort to identify predictors of VTE in hospitalized COVID-19 patients, as a path to promote prevention, early diagnosis and treatment [ 9 , 10 , 19 – 21 ].…”

Effects of SARS-CoV-2 infections in patients with cancer on mortality, ICU admission and incidence: a systematic review with meta-analysis involving 709,908 participants and 31,732 cancer patients

“…After a preliminary review and the elimination of duplicates, 5328 papers were screened and chosen for further evaluation. A total of 58 studies (Adejumo et al 2021 ; Akhtar et al 2021 ; Alpert et al 2021 ; Arslan et al 2021 ; Azarkar et al 2021 ; Baker et al 2021 ; Benelli et al 2020 ; Bennett et al 2021 ; Bergman et al 2021 ; Bernard et al 2021 ; Bhargava et al 2021 ; Borobia et al 2020 ; Pinto et al 2020 ; Chai et al 2021 ; Fu et al 2021 ; Chudasama et al 2021 ; Costa et al 2021 ; Duanmu et al 2020 ; Gold et al 2020 ; Görgülü et al 2020 ; Goyal et al 2020 ; Gude-Sampedro et al 2021 ; Guo et al 2021 ; Joharatnam-Hogan et al 2020 ; Katkat et al 2021 ; Kim et al 2021 ; Kokturk et al 2021 ; Liang et al 2021 ; Sun et al 2021 ; Cavanna et al 2020 ; Lunski et al 2021 ; Martinot et al 2021 ; Mirgh et al 2021 ; Miyashita et al 2020 ; Nakamura et al 2021 ; Nikpouraghdam et al 2020 ; Panda et al 2022 ; Péron et al 2021 ; Poli et al 2022 ; Li et al 2020a , b ; Reddy et al 2021 ; Regina et al 2020 ; Ricoca-Peixoto et al 2020 ; Giorgi-Rossi et al 2020 ; Rugge et al 2020 ; Erdal et al 2021 ; Sami et al 2020 ; Santorelli et al 2021 ; Pérez-Segura et al 2021 ; Serraino et al 2021 ; Shahidsales et al 2021 ; Sorouri et al 2020 ; Stroppa et al 2020 ; Tehrani et al 2021 ; Vergara et al 2021 ; Vila-Corcoles et al 20...…”

“…A total of 42 studies (Akhtar et al 2021 ; Alpert et al 2021 ; Arslan et al 2021 ; Azarkar et al 2021 ; Baker et al 2021 ; Benelli et al 2020 ; Bennett et al 2021 ; Bernard et al 2021 ; Bhargava et al 2021 ; Borobia et al 2020 ; Pinto et al 2020 ; Chai et al 2021 ; Fu et al 2021 ; Gude-Sampedro et al 2021 ; Guo et al 2021 ; Joharatnam-Hogan et al 2020 ; Katkat et al 2021 ; Kim et al 2021 ; Kokturk et al 2021 ; Liang et al 2021 ; Sun et al 2021 ; Lunski et al 2021 ; Martinot et al 2021 ; Mirgh et al 2021 ; Miyashita et al 2020 ; Péron et al 2021 ; Poli et al 2022 ; Li et al 2020a , b ; Reddy et al 2021 ; Ricoca Peixoto et al 2020 ; Giorgi-Rossi et al 2020; Rugge et al 2020 ; Erdal et al 2021 ; Pérez-Segura et al 2021 ; Serraino et al 2021 ; Shahidsales et al 2021 ; Sorouri et al 2020 ; Stroppa et al 2020 ; Vergara et al 2021 ; Vila-Corcoles et al 2021 ; Zhang et al 2021 ; Zhou et al 2021 ) were included in the analysis to compare the mortality rates of cancer and non-cancer patients infected with SARS-CoV-2. There were a total of 557,053 participants, of whom 21,599 were cancer patients.…”

Heparanase Is a Putative Mediator of Endothelial Glycocalyx Damage in COVID-19 – A Proof-of-Concept Study

“…At the clinical level, the administration of heparin and/or LMWH has been shown to provide a significant survival benefit in both entities (33)(34)(35). Hence, apart from the anticoagulant effect of heparin the non-anticoagulant and, among these, especially anti-inflammatory properties should not be neglected and deserve closer attention (36).…”