Low molecular weight heparin is useful in adult COVID-19 inpatients. Experience during the first Spanish wave: observational study
São Paulo med. j
; 140(1): 123-133, Jan.-Feb. 2022. tab, graf
Artigo
em Inglês
| LILACS
| ID: biblio-1357464
Biblioteca responsável:
BR1.1
ABSTRACT
ABSTRACT BACKGROUND:
The intensity of the thromboprophylaxis needed as a potential factor for preventing inpatient mortality due to coronavirus disease-19 (COVID-19) remains unclear.OBJECTIVE:
To explore the association between anticoagulation intensity and COVID-19 survival. DESIGN ANDSETTING:
Retrospective observational study in a tertiary-level hospital in Spain.METHODS:
Low-molecular-weight heparin (LMWH) status was ascertained based on prescription at admission. To control for immortal time bias, anticoagulant use was analyzed as a time-dependent variable.RESULTS:
690 patients were included (median age, 72 years). LMWH was administered to 615 patients, starting from hospital admission (89.1%). 410 (66.7%) received prophylactic-dose LMWH; 120 (19.5%), therapeutic-dose LMWH; and another 85 (13.8%) who presented respiratory failure, high D-dimer levels (> 3 mg/l) and non-worsening of inflammation markers received prophylaxis of intermediate-dose LMWH. The overall inpatient-mortality rate was 38.5%. The anticoagulant nonuser group presented higher mortality risk than each of the following groups any LMWH users (HR 2.1; 95% CI 1.40-3.15); the prophylactic-dose heparin group (HR 2.39; 95% CI, 1.57-3.64); and the users of heparin dose according to biomarkers (HR 6.52; 95% CI, 2.95-14.41). 3.4% of the patients experienced major hemorrhage. 2.8% of the patients developed an episode of thromboembolism.CONCLUSIONS:
This observational study showed that LMWH administered at the time of admission was associated with lower mortality among unselected adult COVID-19 inpatients. The magnitude of the benefit may have been greatest for the intermediate-dose subgroup. Randomized controlled trials to assess the benefit of heparin within different therapeutic regimes for COVID-19 patients are required.
Texto completo:
Disponível
Coleções:
Bases de dados internacionais
Contexto em Saúde:
ODS3 - Meta 3.3 Acabar com as doenças tropicais negligenciadas e combater as doenças transmissíveis
/
ODS3 - Meta 3.4 Reduzir as mortes prematuras devido doenças não transmissíveis
Problema de saúde:
COVID-19
/
Pneumonía
/
Doença Cardiovascular
/
Outras Doenças Respiratórias
/
Tromboembolismo Venoso
Base de dados:
LILACS
Assunto principal:
Tromboembolia Venosa
/
COVID-19
Tipo de estudo:
Ensaio clínico controlado
/
Estudo observacional
Limite:
Adulto
/
Idoso
/
Humanos
Idioma:
Inglês
Revista:
São Paulo med. j
Assunto da revista:
Cirurgia Geral
/
Cincia
/
Ginecologia
/
Medicina
/
Medicina Interna
/
Obstetr¡cia
/
Pediatria
/
Sa£de Mental
/
Sa£de P£blica
Ano de publicação:
2022
Tipo de documento:
Artigo
País de afiliação:
Espanha
Instituição/País de afiliação:
Universidad de Salamanca/ES