Preliminary Experience With Low Molecular Weight Heparin Strategy in COVID-19 Patients
Preliminary Experience With Low Molecular Weight Heparin Strategy in COVID-19 Patients
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DOI：
10.3389/fphar.2020.01124
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发表时间：
2020-08-06
影响因子：
5.6
通讯作者：
Galie, Nazzareno
中科院分区：
文献类型：
--
作者：
Paolisso, Pasquale;Bergamaschi, Luca;Galie, Nazzareno
背景 尽管有关剂量、持续时间和疗效的证据有限，但专家共识建议对 COVID-19 患者使用肝素。我们的目的是研究不同剂量的低分子肝素 (LMWH) 与 COVID-19 住院患者死亡率之间的关联。方法和结果对2020年3月1日至4月10日入住圣奥索拉博洛尼亚医院的450例实验室确诊的COVID-19患者进行回顾性研究。收集并分析临床、实验室和治疗数据。比较了接受标准预防性 LMWH 剂量与中间 LMWH 剂量治疗的 COVID-19 患者的院内死亡率。在 450 名患者中，361 名患者接受标准的深静脉血栓 (DVT) 预防依诺肝素治疗（每天 40-60 毫克），89 名患者接受中等依诺肝素剂量（40-60 毫克，每天两次），持续 7 天。除了接受“标准”预防性 LMWH 剂量治疗组的年龄较大和高血压患病率外，在两个肝素治疗方案亚组中，在主要人口统计学特征和入院时实验室检查方面没有观察到显着差异。与“标准”预防性 LMWH 剂量相比，中间 LMWH 给药与较低的院内全因死亡率相关（18.8% vs. 5.8%，p = 0.02）。在对剂量组之间差异显着的变量的倾向评分进行调整后，这种差异仍然显着（OR= 0.260，95% CI 0.089-0.758，p=0.014）。结论 与标准 DVT 预防相比，中等 LMWH 剂量似乎与住院 COVID-19 患者较低的死亡率相关。我们的研究为 Covid-19 疾病抗凝治疗的进一步病理生理学研究和对照研究铺平了道路。
Background Heparin administration in COVID-19 patients is recommended by expert consensus, although evidence about dosage, duration and efficacy are limited. We aim to investigate the association between different dosages of low molecular weight heparin (LMWH) and mortality among COVID-19 hospitalized patients. Methods and Results Retrospective study of 450 laboratory-confirmed COVID-19 patients admitted to Sant'Orsola Bologna Hospital from March 01 to April 10, 2020. Clinical, laboratory and treatment data were collected and analyzed. The in-hospital mortality between COVID-19 patients treated with standard prophylactic LMWH dosage vs. intermediate LMWH dosage was compared. Out of 450 patients, 361 received standard deep vein thrombosis (DVT) prophylaxis enoxaparin treatment (40-60mg daily) and 89 patients received intermediate enoxaparin dosage (40-60 mg twice daily) for 7 days. No significant differences in the main demographic characteristics and laboratory testings at admission were observed in the two heparin regimen subgroups, except for older age and prevalence of hypertension in the group treated with "standard" prophylaxis LMWH dosage. The intermediate LMWH administration was associated with a lower in-hospital all-cause mortality compared to the "standard" prophylactic LMWH dosage (18.8% vs. 5.8%, p = 0.02). This difference remained significant after adjustment with the propensity score for variables that differed significantly between the dosage groups (OR= 0.260, 95% CI 0.089-0.758, p=0.014). Conclusions Intermediate LMWH dosage seems to be associated with lower incidence of mortality compared to standard DVT prophylaxys in hospitalized COVID-19 patients. Our study paves the way to further pathophysiological investigations and controlled studies of anticoagulation therapy in Covid-19 disease.