Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia

Prophylactic low molecular weight heparin (pLMWH) is currently recommended in COVID-19 to reduce the risk of coagulopathy. The aim of this study was to evaluate whether the antinflammatory effects of pLMWH could translate in lower rate of clinical progression in patients with COVID-19 pneumonia. Pat...

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Autores principales: Vergori, Alessandra, Lorenzini, Patrizia, Cozzi-Lepri, Alessandro, Donno, Davide Roberto, Gualano, Gina, Nicastri, Emanuele, Iacomi, Fabio, Marchioni, Luisa, Campioni, Paolo, Schininà, Vincenzo, Cicalini, Stefania, Agrati, Chiara, Capobianchi, Maria Rosaria, Girardi, Enrico, Ippolito, Giuseppe, Vaia, Francesco, Petrosillo, Nicola, Antinori, Andrea, Taglietti, Fabrizio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167179/
https://www.ncbi.nlm.nih.gov/pubmed/34059708
http://dx.doi.org/10.1038/s41598-021-90713-6
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author Vergori, Alessandra
Lorenzini, Patrizia
Cozzi-Lepri, Alessandro
Donno, Davide Roberto
Gualano, Gina
Nicastri, Emanuele
Iacomi, Fabio
Marchioni, Luisa
Campioni, Paolo
Schininà, Vincenzo
Cicalini, Stefania
Agrati, Chiara
Capobianchi, Maria Rosaria
Girardi, Enrico
Ippolito, Giuseppe
Vaia, Francesco
Petrosillo, Nicola
Antinori, Andrea
Taglietti, Fabrizio
author_facet Vergori, Alessandra
Lorenzini, Patrizia
Cozzi-Lepri, Alessandro
Donno, Davide Roberto
Gualano, Gina
Nicastri, Emanuele
Iacomi, Fabio
Marchioni, Luisa
Campioni, Paolo
Schininà, Vincenzo
Cicalini, Stefania
Agrati, Chiara
Capobianchi, Maria Rosaria
Girardi, Enrico
Ippolito, Giuseppe
Vaia, Francesco
Petrosillo, Nicola
Antinori, Andrea
Taglietti, Fabrizio
author_sort Vergori, Alessandra
collection PubMed
description Prophylactic low molecular weight heparin (pLMWH) is currently recommended in COVID-19 to reduce the risk of coagulopathy. The aim of this study was to evaluate whether the antinflammatory effects of pLMWH could translate in lower rate of clinical progression in patients with COVID-19 pneumonia. Patients admitted to a COVID-hospital in Rome with SARS-CoV-2 infection and mild/moderate pneumonia were retrospectively evaluated. The primary endpoint was the time from hospital admission to orotracheal intubation/death (OTI/death). A total of 449 patients were included: 39% female, median age 63 (IQR, 50–77) years. The estimated probability of OTI/death for patients receiving pLMWH was: 9.5% (95% CI 3.2–26.4) by day 20 in those not receiving pLMWH vs. 10.4% (6.7–15.9) in those exposed to pLMWH; p-value = 0.144. This risk associated with the use of pLMWH appeared to vary by PaO(2)/FiO(2) ratio: aHR 1.40 (95% CI 0.51–3.79) for patients with an admission PaO(2)/FiO(2) ≤ 300 mmHg and 0.27 (0.03–2.18) for those with PaO(2)/FiO(2) > 300 mmHg; p-value at interaction test 0.16. pLMWH does not seem to reduce the risk of OTI/death mild/moderate COVID-19 pneumonia, especially when respiratory function had already significantly deteriorated. Data from clinical trials comparing the effect of prophylactic vs. therapeutic dosage of LMWH at various stages of COVID-19 disease are needed.
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spelling pubmed-81671792021-06-02 Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia Vergori, Alessandra Lorenzini, Patrizia Cozzi-Lepri, Alessandro Donno, Davide Roberto Gualano, Gina Nicastri, Emanuele Iacomi, Fabio Marchioni, Luisa Campioni, Paolo Schininà, Vincenzo Cicalini, Stefania Agrati, Chiara Capobianchi, Maria Rosaria Girardi, Enrico Ippolito, Giuseppe Vaia, Francesco Petrosillo, Nicola Antinori, Andrea Taglietti, Fabrizio Sci Rep Article Prophylactic low molecular weight heparin (pLMWH) is currently recommended in COVID-19 to reduce the risk of coagulopathy. The aim of this study was to evaluate whether the antinflammatory effects of pLMWH could translate in lower rate of clinical progression in patients with COVID-19 pneumonia. Patients admitted to a COVID-hospital in Rome with SARS-CoV-2 infection and mild/moderate pneumonia were retrospectively evaluated. The primary endpoint was the time from hospital admission to orotracheal intubation/death (OTI/death). A total of 449 patients were included: 39% female, median age 63 (IQR, 50–77) years. The estimated probability of OTI/death for patients receiving pLMWH was: 9.5% (95% CI 3.2–26.4) by day 20 in those not receiving pLMWH vs. 10.4% (6.7–15.9) in those exposed to pLMWH; p-value = 0.144. This risk associated with the use of pLMWH appeared to vary by PaO(2)/FiO(2) ratio: aHR 1.40 (95% CI 0.51–3.79) for patients with an admission PaO(2)/FiO(2) ≤ 300 mmHg and 0.27 (0.03–2.18) for those with PaO(2)/FiO(2) > 300 mmHg; p-value at interaction test 0.16. pLMWH does not seem to reduce the risk of OTI/death mild/moderate COVID-19 pneumonia, especially when respiratory function had already significantly deteriorated. Data from clinical trials comparing the effect of prophylactic vs. therapeutic dosage of LMWH at various stages of COVID-19 disease are needed. Nature Publishing Group UK 2021-05-31 /pmc/articles/PMC8167179/ /pubmed/34059708 http://dx.doi.org/10.1038/s41598-021-90713-6 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Vergori, Alessandra
Lorenzini, Patrizia
Cozzi-Lepri, Alessandro
Donno, Davide Roberto
Gualano, Gina
Nicastri, Emanuele
Iacomi, Fabio
Marchioni, Luisa
Campioni, Paolo
Schininà, Vincenzo
Cicalini, Stefania
Agrati, Chiara
Capobianchi, Maria Rosaria
Girardi, Enrico
Ippolito, Giuseppe
Vaia, Francesco
Petrosillo, Nicola
Antinori, Andrea
Taglietti, Fabrizio
Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia
title Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia
title_full Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia
title_fullStr Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia
title_full_unstemmed Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia
title_short Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia
title_sort prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate covid-19 pneumonia
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167179/
https://www.ncbi.nlm.nih.gov/pubmed/34059708
http://dx.doi.org/10.1038/s41598-021-90713-6
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