Role of Low-Molecular-Weight Heparin in Hospitalized Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia: A Prospective Observational Study.
Role of Low-Molecular-Weight Heparin in Hospitalized Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia: A Prospective Observational Study.
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DOI：
10.1093/ofid/ofaa563
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发表时间：
2020-12
影响因子：
4.2
通讯作者：
Pisa COVID-19 Study Group
中科院分区：
文献类型：
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作者：
Falcone M;Tiseo G;Barbieri G;Galfo V;Russo A;Virdis A;Forfori F;Corradi F;Guarracino F;Carrozzi L;Celi A;Santini M;Monzani F;De Marco S;Pistello M;Danesi R;Ghiadoni L;Farcomeni A;Menichetti F;Pisa COVID-19 Study Group
本研究旨在评估低分子肝素 (LMWH) 对严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 肺炎患者预后的影响。这是一项前瞻性观察性研究，纳入了比萨大学医院（2020 年 3 月 4 日至 4 月 30 日）收治的连续实验室确诊的 SARS-CoV-2 肺炎患者。收集人口统计、临床和结果数据。主要终点是 30 天死亡率。次要终点是死亡或严重急性呼吸窘迫综合征（ARDS）的复合终点。低分子量肝素、羟氯喹、多西环素、大环内酯类、抗逆转录病毒药物、瑞德西韦、巴瑞替尼、托珠单抗和类固醇被评估为感兴趣的治疗暴露。首先，进行 Cox 回归分析，其中将治疗作为时间相关变量引入，以评估暴露和结果的关联。然后，计算时间依赖性倾向评分（PS），并对每个治疗变量进行 PS 匹配。在 315 名 SARS-CoV-2 肺炎患者中，70 名（22.2%）在住院期间死亡。 114 名 (36.2%) 患者实现了复合终点。总体而言，244 名患者（77.5%）接受了 LMWH，238 名患者（75.5%）接受了羟氯喹，201 名患者（63.8%）接受了蛋白酶抑制剂，150 名患者（47.6%）接受了多西环素，141 名患者（44.8%）接受了类固醇，42 名患者（13.3%）接受了大环内酯类药物，40 名患者（12.7%）接受了大环内酯类药物治疗。巴瑞克替尼，13 名（4.1%）接受托珠单抗，13 名（4.1%）接受瑞德西韦。在多变量分析中，LMWH 与 30 天死亡率风险降低相关（风险比 [HR]，0.36；95% 置信区间 [CI]，0.21–0.6；P < .001）和复合终点（HR，0.61；95% CI，0.39–0.95；P = .029）。由 55 对夫妇组成的 PS 匹配队列证实了主要和次要终点的相同结果。这项研究表明，LMWH 可能会降低 2019 年冠状病毒病的院内死亡和严重 ARDS 的风险。有必要进行随机对照试验来证实这些初步发现。我们证明低分子量肝素（LMWH）与降低死亡风险相关。 LMWH 可能会减少 COVID-19 患者肺部小血管的微血栓形成。需要进行随机临床试验来确认 LMWH 在 COVID-19 中的作用。
This study was conducted to evaluate the impact of low-molecular-weight heparin (LMWH) on the outcome of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. This is a prospective observational study including consecutive patients with laboratory-confirmed SARS-CoV-2 pneumonia admitted to the University Hospital of Pisa (March 4–April 30, 2020). Demographic, clinical, and outcome data were collected. The primary endpoint was 30-day mortality. The secondary endpoint was a composite of death or severe acute respiratory distress syndrome (ARDS). Low-molecular-weight heparin, hydroxychloroquine, doxycycline, macrolides, antiretrovirals, remdesivir, baricitinib, tocilizumab, and steroids were evaluated as treatment exposures of interest. First, a Cox regression analysis, in which treatments were introduced as time-dependent variables, was performed to evaluate the association of exposures and outcomes. Then, a time-dependent propensity score (PS) was calculated and a PS matching was performed for each treatment variable. Among 315 patients with SARS-CoV-2 pneumonia, 70 (22.2%) died during hospital stay. The composite endpoint was achieved by 114 (36.2%) patients. Overall, 244 (77.5%) patients received LMWH, 238 (75.5%) received hydroxychloroquine, 201 (63.8%) received proteases inhibitors, 150 (47.6%) received doxycycline, 141 (44.8%) received steroids, 42 (13.3%) received macrolides, 40 (12.7%) received baricitinib, 13 (4.1%) received tocilizumab, and 13 (4.1%) received remdesivir. At multivariate analysis, LMWH was associated with a reduced risk of 30-day mortality (hazard ratio [HR], 0.36; 95% confidence interval [CI], 0.21–0.6; P < .001) and composite endpoint (HR, 0.61; 95% CI, 0.39–0.95; P = .029). The PS-matched cohort of 55 couples confirmed the same results for both primary and secondary endpoint. This study suggests that LMWH might reduce the risk of in-hospital mortality and severe ARDS in coronavirus disease 2019. Randomized controlled trials are warranted to confirm these preliminary findings. We show that low-molecular-weight heparin (LMWH) is associated with reduced risk of mortality. LMWH may reduce microthrombosis of pulmonary small vessels in patients with COVID-19. Randomized clinical trials are warranted to confirm the role of LMWH in COVID-19.
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影响因子：
11.8
作者：
Violi, Francesco;Cangemi, Roberto;Corrales-Medina, Vicente F.
通讯作者：
Corrales-Medina, Vicente F.
影响因子：
11.8
作者：
Ji, Dong;Zhang, Dawei;Qin, Enqiang
通讯作者：
Qin, Enqiang
影响因子：
10.4
作者：
Thachil, Jecko;Juffermans, Nicole P.;Levy, Jerrold H.
通讯作者：
Levy, Jerrold H.
DOI：
10.1001/jama.2020.6775
发表时间：
2020-01-01
期刊：
JAMA, Journal of the American Medical Association
影响因子：
--
作者：
Richardson, Safiya;Hirsch, Jamie S.;,
通讯作者：
,
影响因子：
24
作者：
Cangemi, Roberto;Casciaro, Marco;Violi, Francesco
通讯作者：
Violi, Francesco