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J Thromb Haemost. 2020 Mar 27. doi: 10.1111/jth.14817. [Epub ahead of print]
Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy.
Tang N1, Bai H1, Chen X1, Gong J1, Li D2, Sun Z1.
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Abstract
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.
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KEYWORDS:
D-dimer; coagulopathy; coronavirus disease 2019; low molecular weight heparin; sepsis
PMID:32220112DOI:10.1111/jth.14817