Heparin in COVID-19 Patients Is Associated with Reduced In-Hospital Mortality: The Multicenter Italian CORIST Study

Medientyp: E-Artikel
Titel: Heparin in COVID-19 Patients Is Associated with Reduced In-Hospital Mortality: The Multicenter Italian CORIST Study
Beteiligte: Di Castelnuovo, Augusto; Costanzo, Simona; Antinori, Andrea; Berselli, Nausicaa; Blandi, Lorenzo; Bonaccio, Marialaura; Cauda, Roberto; Guaraldi, Giovanni; Menicanti, Lorenzo; Mennuni, Marco; Parruti, Giustino; Patti, Giuseppe; Santilli, Francesca; Signorelli, Carlo; Vergori, Alessandra; Abete, Pasquale; Ageno, Walter; Agodi, Antonella; Agostoni, Piergiuseppe; Aiello, Luca; Al Moghazi, Samir; Arboretti, Rosa; Astuto, Marinella; Aucella, Filippo; [...]
Erschienen: Georg Thieme Verlag KG, 2021
Erschienen in: Thrombosis and Haemostasis
Sprache: Englisch
DOI: 10.1055/a-1347-6070
ISSN: 0340-6245; 2567-689X
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Beschreibung: <jats:title>Abstract</jats:title><jats:p> Introduction A hypercoagulable condition was described in patients with coronavirus disease 2019 (COVID-19) and proposed as a possible pathogenic mechanism contributing to disease progression and lethality.</jats:p><jats:p> Aim We evaluated if in-hospital administration of heparin improved survival in a large cohort of Italian COVID-19 patients.</jats:p><jats:p> Methods In a retrospective observational study, 2,574 unselected patients hospitalized in 30 clinical centers in Italy from February 19, 2020 to June 5, 2020 with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 infection were analyzed. The primary endpoint in a time-to event analysis was in-hospital death, comparing patients who received heparin (low-molecular-weight heparin [LMWH] or unfractionated heparin [UFH]) with patients who did not. We used multivariable Cox proportional-hazards regression models with inverse probability for treatment weighting by propensity scores.</jats:p><jats:p> Results Out of 2,574 COVID-19 patients, 70.1% received heparin. LMWH was largely the most used formulation (99.5%). Death rates for patients receiving heparin or not were 7.4 and 14.0 per 1,000 person-days, respectively. After adjustment for propensity scores, we found a 40% lower risk of death in patients receiving heparin (hazard ratio = 0.60; 95% confidence interval: 0.49–0.74; E-value = 2.04). This association was particularly evident in patients with a higher severity of disease or strong coagulation activation.</jats:p><jats:p> Conclusion In-hospital heparin treatment was associated with a lower mortality, particularly in severely ill COVID-19 patients and in those with strong coagulation activation. The results from randomized clinical trials are eagerly awaited to provide clear-cut recommendations.</jats:p>

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