Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy
ISTH Academy. Sun Z. 03/27/20; 290512
Ziyong Sun
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Answers to questions about COVID-19 published herein are provided by the International Society on Thrombosis and Haemostasis, Inc. (“ISTH”) for voluntary, informational use by providers in the rapidly evolving novel coronavirus crisis. This information does not constitute medical or legal advice, is not intended for use in the diagnosis or treatment of individual conditions, does not endorse products or therapies, recommend or mandate any particular course of medical care, and is not a statement of the standard of care. New evidence may emerge between the time information is developed and when it is published or read. The information is not comprehensive or continually updated. This information is not intended to substitute for the independent professional judgment of the treating provider in the context of treating the individual patient. ISTH provides this information on an “as is” basis, and makes no warranty, express or implied, regarding the information, including but not limited to its completeness or accuracy. ISTH specifically disclaims any warranties of merchantability or fitness for a particular use or purpose. ISTH assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this information or for any errors or omissions. Use of the information is subject to the complete ISTH website Terms of Use.
The appearance of external hyperlinks does not constitute endorsement by ISTH of the linked websites, or the information, products or services contained therein. ISTH does not exercise any editorial control over the information you may find at these locations nor does ISTH make any representation of their accuracy or completeness. Please contact those websites with any questions.
Background
A relatively high mortality of severe coronavirus disease 2019 (COVID‐19) is worrying, the application of heparin in COVID‐19 has been recommended by some expert consensus due to the risk of disseminated intravascular coagulation and venous thromboembolism. However, its efficacy remains to be validated.
Methods
Coagulation results, medications and outcomes of consecutive patients being classified as severe COVID‐19 in Tongji hospital were retrospectively analysed. The 28‐day mortality between heparin users and nonusers were compared, also in different risk of coagulopaphy which was stratified by the sepsis‐induced coagulopathy (SIC) score or D‐dimer result.
Results
There were 449 patients with severe COVID‐19 enrolled into the study, 99 of them received heparin (mainly with low molecular weight heparin, LMWH) for 7 days or longer. The D‐dimer, prothrombin time and age were positively, and platelet count was negatively, correlated with 28‐day mortality in multivariate analysis. No difference on 28‐day mortality was found between heparin users and nonusers (30.3% vs 29.7%, P=0.910). But the 28‐day mortality of heparin users were lower than nonusers In patients with SIC score ≥4 (40.0% vs 64.2%, P=0.029), or D‐dimer > 6 fold of upper limit of normal (32.8% vs 52.4%, P=0.017).
Conclusions
Anticoagulant therapy mainly with LMWH appears to be associated with better prognosis in severe COVID‐19 patients meeting SIC criteria or with markedly elevated D‐dimer.
A relatively high mortality of severe coronavirus disease 2019 (COVID‐19) is worrying, the application of heparin in COVID‐19 has been recommended by some expert consensus due to the risk of disseminated intravascular coagulation and venous thromboembolism. However, its efficacy remains to be validated.
Methods
Coagulation results, medications and outcomes of consecutive patients being classified as severe COVID‐19 in Tongji hospital were retrospectively analysed. The 28‐day mortality between heparin users and nonusers were compared, also in different risk of coagulopaphy which was stratified by the sepsis‐induced coagulopathy (SIC) score or D‐dimer result.
Results
There were 449 patients with severe COVID‐19 enrolled into the study, 99 of them received heparin (mainly with low molecular weight heparin, LMWH) for 7 days or longer. The D‐dimer, prothrombin time and age were positively, and platelet count was negatively, correlated with 28‐day mortality in multivariate analysis. No difference on 28‐day mortality was found between heparin users and nonusers (30.3% vs 29.7%, P=0.910). But the 28‐day mortality of heparin users were lower than nonusers In patients with SIC score ≥4 (40.0% vs 64.2%, P=0.029), or D‐dimer > 6 fold of upper limit of normal (32.8% vs 52.4%, P=0.017).
Conclusions
Anticoagulant therapy mainly with LMWH 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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