tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2020 Nov 19;7(12)
faa563.
doi: 10.1093/ofid/ofaa563. eCollection 2020 Dec.
Role of Low-Molecular-Weight Heparin in Hospitalized Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia: A Prospective Observational Study
Marco Falcone[SUP] 1 [/SUP], Giusy Tiseo[SUP] 1 [/SUP], Greta Barbieri[SUP] 2 [/SUP], Valentina Galfo[SUP] 1 [/SUP], Alessandro Russo[SUP] 1 [/SUP], Agostino Virdis[SUP] 3 [/SUP], Francesco Forfori[SUP] 4 [/SUP], Francesco Corradi[SUP] 4 5 [/SUP], Fabio Guarracino[SUP] 6 [/SUP], Laura Carrozzi[SUP] 4 [/SUP], Alessandro Celi[SUP] 4 [/SUP], Massimo Santini[SUP] 7 [/SUP], Fabio Monzani[SUP] 8 [/SUP], Salvatore De Marco[SUP] 9 [/SUP], Mauro Pistello[SUP] 10 [/SUP], Romano Danesi[SUP] 11 [/SUP], Lorenzo Ghiadoni[SUP] 2 [/SUP], Alessio Farcomeni[SUP] 12 [/SUP], Francesco Menichetti[SUP] 1 [/SUP], Pisa COVID-19 Study Group
Collaborators, Affiliations
Abstract
Background: This study was conducted to evaluate the impact of low-molecular-weight heparin (LMWH) on the outcome of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia.
Methods: This is a prospective observational study including consecutive patients with laboratory-confirmed SARS-CoV-2 pneumonia admitted to the University Hospital of Pisa (March 4-April 30, 2020). Demographic, clinical, and outcome data were collected. The primary endpoint was 30-day mortality. The secondary endpoint was a composite of death or severe acute respiratory distress syndrome (ARDS). Low-molecular-weight heparin, hydroxychloroquine, doxycycline, macrolides, antiretrovirals, remdesivir, baricitinib, tocilizumab, and steroids were evaluated as treatment exposures of interest. First, a Cox regression analysis, in which treatments were introduced as time-dependent variables, was performed to evaluate the association of exposures and outcomes. Then, a time-dependent propensity score (PS) was calculated and a PS matching was performed for each treatment variable.
Results: Among 315 patients with SARS-CoV-2 pneumonia, 70 (22.2%) died during hospital stay. The composite endpoint was achieved by 114 (36.2%) patients. Overall, 244 (77.5%) patients received LMWH, 238 (75.5%) received hydroxychloroquine, 201 (63.8%) received proteases inhibitors, 150 (47.6%) received doxycycline, 141 (44.8%) received steroids, 42 (13.3%) received macrolides, 40 (12.7%) received baricitinib, 13 (4.1%) received tocilizumab, and 13 (4.1%) received remdesivir. At multivariate analysis, LMWH was associated with a reduced risk of 30-day mortality (hazard ratio
, 0.36; 95% confidence interval [CI], 0.21-0.6; P < .001) and composite endpoint (HR, 0.61; 95% CI, 0.39-0.95; P = .029). The PS-matched cohort of 55 couples confirmed the same results for both primary and secondary endpoint.
Conclusions: This study suggests that LMWH might reduce the risk of in-hospital mortality and severe ARDS in coronavirus disease 2019. Randomized controlled trials are warranted to confirm these preliminary findings.
Keywords: ARDS; COVID-19; SARS-CoV-2; low-molecular weight; mortality.
. 2020 Nov 19;7(12)
faa563.doi: 10.1093/ofid/ofaa563. eCollection 2020 Dec.
Role of Low-Molecular-Weight Heparin in Hospitalized Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia: A Prospective Observational Study
Marco Falcone[SUP] 1 [/SUP], Giusy Tiseo[SUP] 1 [/SUP], Greta Barbieri[SUP] 2 [/SUP], Valentina Galfo[SUP] 1 [/SUP], Alessandro Russo[SUP] 1 [/SUP], Agostino Virdis[SUP] 3 [/SUP], Francesco Forfori[SUP] 4 [/SUP], Francesco Corradi[SUP] 4 5 [/SUP], Fabio Guarracino[SUP] 6 [/SUP], Laura Carrozzi[SUP] 4 [/SUP], Alessandro Celi[SUP] 4 [/SUP], Massimo Santini[SUP] 7 [/SUP], Fabio Monzani[SUP] 8 [/SUP], Salvatore De Marco[SUP] 9 [/SUP], Mauro Pistello[SUP] 10 [/SUP], Romano Danesi[SUP] 11 [/SUP], Lorenzo Ghiadoni[SUP] 2 [/SUP], Alessio Farcomeni[SUP] 12 [/SUP], Francesco Menichetti[SUP] 1 [/SUP], Pisa COVID-19 Study Group
Collaborators, Affiliations
- PMID: 33365358
- PMCID: PMC7717381
- DOI: 10.1093/ofid/ofaa563
Abstract
Background: This study was conducted to evaluate the impact of low-molecular-weight heparin (LMWH) on the outcome of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia.
Methods: This is a prospective observational study including consecutive patients with laboratory-confirmed SARS-CoV-2 pneumonia admitted to the University Hospital of Pisa (March 4-April 30, 2020). Demographic, clinical, and outcome data were collected. The primary endpoint was 30-day mortality. The secondary endpoint was a composite of death or severe acute respiratory distress syndrome (ARDS). Low-molecular-weight heparin, hydroxychloroquine, doxycycline, macrolides, antiretrovirals, remdesivir, baricitinib, tocilizumab, and steroids were evaluated as treatment exposures of interest. First, a Cox regression analysis, in which treatments were introduced as time-dependent variables, was performed to evaluate the association of exposures and outcomes. Then, a time-dependent propensity score (PS) was calculated and a PS matching was performed for each treatment variable.
Results: Among 315 patients with SARS-CoV-2 pneumonia, 70 (22.2%) died during hospital stay. The composite endpoint was achieved by 114 (36.2%) patients. Overall, 244 (77.5%) patients received LMWH, 238 (75.5%) received hydroxychloroquine, 201 (63.8%) received proteases inhibitors, 150 (47.6%) received doxycycline, 141 (44.8%) received steroids, 42 (13.3%) received macrolides, 40 (12.7%) received baricitinib, 13 (4.1%) received tocilizumab, and 13 (4.1%) received remdesivir. At multivariate analysis, LMWH was associated with a reduced risk of 30-day mortality (hazard ratio
, 0.36; 95% confidence interval [CI], 0.21-0.6; P < .001) and composite endpoint (HR, 0.61; 95% CI, 0.39-0.95; P = .029). The PS-matched cohort of 55 couples confirmed the same results for both primary and secondary endpoint.
Conclusions: This study suggests that LMWH might reduce the risk of in-hospital mortality and severe ARDS in coronavirus disease 2019. Randomized controlled trials are warranted to confirm these preliminary findings.
Keywords: ARDS; COVID-19; SARS-CoV-2; low-molecular weight; mortality.