• Sao Paulo Med J · Jan 2022

    Observational Study

    Low molecular weight heparin is useful in adult COVID-19 inpatients. Experience during the first Spanish wave: observational study.

    • Jose Ramon Gonzalez-Porras, Moncef Belhassen-Garcia, Amparo Lopez-Bernus, Luis Mario Vaquero-Roncero, Beatriz Rodriguez, Cristina Carbonell, Raul Azibeiro, Alberto Hernandez-Sanchez, Jose Ignacio Martin-Gonzalez, Juan Miguel Manrique, Gloria Alonso-Claudio, Felipe Alvarez-Navia, Jose Ignacio Madruga-Martin, Ronald Paul Macias-Casanova, Jorge García-Criado, Francisco Lozano, Jose Carlos Moyano, Miguel Vicente Sanchez-Hernandez, Víctor Sagredo-Meneses, Rafael Borras, Jose María Bastida, Guillermo Hernández-Pérez, Antonio Javier Chamorro, Miguel Marcos, and Jose Angel Martin-Oterino.
    • MD, PhD. Physician, Department of Hematology, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Salamanca, Spain.
    • Sao Paulo Med J. 2022 Jan 1; 140 (1): 123133123-133.

    BackgroundThe intensity of the thromboprophylaxis needed as a potential factor for preventing inpatient mortality due to coronavirus disease-19 (COVID-19) remains unclear.ObjectiveTo explore the association between anticoagulation intensity and COVID-19 survival.Design And SettingRetrospective observational study in a tertiary-level hospital in Spain.MethodsLow-molecular-weight heparin (LMWH) status was ascertained based on prescription at admission. To control for immortal time bias, anticoagulant use was analyzed as a time-dependent variable.Results690 patients were included (median age, 72 years). LMWH was administered to 615 patients, starting from hospital admission (89.1%). 410 (66.7%) received prophylactic-dose LMWH; 120 (19.5%), therapeutic-dose LMWH; and another 85 (13.8%) who presented respiratory failure, high D-dimer levels (> 3 mg/l) and non-worsening of inflammation markers received prophylaxis of intermediate-dose LMWH. The overall inpatient-mortality rate was 38.5%. The anticoagulant nonuser group presented higher mortality risk than each of the following groups: any LMWH users (HR 2.1; 95% CI: 1.40-3.15); the prophylactic-dose heparin group (HR 2.39; 95% CI, 1.57-3.64); and the users of heparin dose according to biomarkers (HR 6.52; 95% CI, 2.95-14.41). 3.4% of the patients experienced major hemorrhage. 2.8% of the patients developed an episode of thromboembolism.ConclusionsThis observational study showed that LMWH administered at the time of admission was associated with lower mortality among unselected adult COVID-19 inpatients. The magnitude of the benefit may have been greatest for the intermediate-dose subgroup. Randomized controlled trials to assess the benefit of heparin within different therapeutic regimes for COVID-19 patients are required.

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