Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy.
Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy.
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DOI：
10.1111/jth.14817
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发表时间：
2020-05
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中科院分区：
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2019年严重冠状病毒病（COVID-19）的死亡率相对较高，令人担忧，由于弥漫性血管内凝血和静脉血栓栓塞的风险，一些专家一致建议在COVID-19中应用肝素。然而，其有效性仍有待验证。回顾性分析了同济医院被归类为重症COVID-19的连续患者的凝血结果、药物和结局。比较了肝素使用者和非使用者之间的28天死亡率，以及凝血病的不同风险，这是根据脓毒症诱导的凝血病（SIC）评分或D-二聚体结果分层的。449例重症COVID-19患者入组研究，其中99例接受肝素（主要为低分子量肝素）治疗7天或更长时间。多变量分析显示，D-二聚体、凝血酶原时间和年龄与28天死亡率呈正相关，血小板计数与28天死亡率呈负相关。肝素使用者和非使用者之间的28天死亡率无差异（30.3% vs 29.7%，P = 0.910）。但在SIC评分≥4分（40.0% vs 64.2%，P = 0.029）或D-二聚体>6倍正常值上限（32.8% vs 52.4%，P = 0.017）的患者中，肝素使用者的28天死亡率低于非使用者。在符合SIC标准或D-二聚体显著升高的重度COVID-19患者中，以低分子量肝素为主的抗凝治疗似乎与更好的预后相关。
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. 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. 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). 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.
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