Editor’s take note: Find the most recent COVID-19 news and steering in Medscape’s Coronavirus Source Center.
Early treatment method with low-molecular-body weight heparin (LMWH) cuts down the risk for dying in people with COVID-19, a retrospective cohort review shows.
Heparin could lessen the danger for blood clots, claimed Andrea De Vito, MD, from the Device of Infectious Conditions at the College of Sassari, Sassari, Italy, through his online presentation of the findings at the 31st European Congress of Clinical Microbiology & Infectious Conditions.
“Quite a few scientific studies try out to explain the role performed by coagulopathies in COVID-19 demise,” but the system leading to them is continue to unclear, De Vito discussed.
Some suggestions have proposed heparin as a treatment method for hospitalized COVID sufferers, but few have appeared at nonhospitalized individuals. In reality, the Nationwide Institutes of Health and fitness discourages the use of heparin in nonhospitalized COVID clients, and assistance for the dwelling care of COVID patients from the Globe Wellness Firm won’t point out heparin treatment at all, he stated.
To take a look at the rewards of early heparin — whether administered at dwelling or in the clinic — De Vito and his colleagues looked at a cohort of more mature grown ups with COVID who ended up evaluated or treated at an Italian university clinic.
“Some individuals had been hospitalized straight away following signs or symptoms onset other people today most popular to get in touch with their common practitioner and started the cure at property,” De Vito advised Medscape Medical News. “Other persons had been hospitalized for worsening of signs afterwards in the training course of the condition.”
Of the 734 clients, 296 acquired heparin within just 5 times of the onset of signs or symptoms or a beneficial COVID check. Of the remaining 438 patients, 196 obtained LMWH treatment method later through the condition study course, and the rest never ever gained LMWH.
All clients who acquired early heparin were being handled with LMWH 4000 IU, or 6000 IU if their human body mass index (BMI) was previously mentioned 30 kg/m2. This was diminished to 2000 IU if believed glomerular filtration amount (eGFR) dropped below 30 mL/min. None of the individuals had earlier been given heparin.
Median age was marginally younger for people who been given early heparin than for all those who did not (76.8 vs 78.5 a long time).
Other demographic traits, these types of as sexual intercourse and BMI, have been equivalent in the two teams, as have been charges of comorbidities, this kind of as hypertension, cardiovascular disorder, diabetes, COPD, kidney illness, and neurologic problems. Also very similar were being the frequency of indicators (such as fever, cough, and shortness of breath) and costs of therapy with remdesivir or steroids.
Rates of hospital admission have been not significantly distinctive in between patients who received early heparin and those who did not (65% vs 61%). There was also no significant distinction in use of a Venturi mask (35% vs 28%), noninvasive ventilation (13% vs 14%), or intubation (5% vs 8%).
Nevertheless, charges of death were being substantially reduced in individuals who gained early heparin than in individuals who did not (13% vs 25% P < .0001).
Table. Factors associated with death in COVID patients
| Factor | Odds Ratio | PValue |
|---|---|---|
| Older age | 1.1 | < .0001 |
| BMI>30 kg/m2 | 2.4 | < .0001 |
| Presence of neurologic disease | 1.6 | .04 |
| Presence of fever | 1.6 | .04 |
| Presence of dyspnea | 3.1 | < .0001 |
| Treatment with remdesivir | 0.5 | .04 |
| Early heparin treatment | 0.4 | < .0001 |
There was a trend toward shorter hospital stays for patients treated with early heparin, but the difference was not significant (median, 10 vs 13 days P = .08).
Researchers also conducted a separate analysis of 219 COVID patients who received LMWH at home, regardless of when during their disease course they received it. These patients were significantly less likely to be hospitalized than patients who did not receive LMWH at home (odds ratio, 0.2 P < .0001).
Comparatively, early heparin treatment had a greater effect on the risk for death and the risk for hospitalization than other factors.
“Thromboemboli are a major complication of COVID. There is good consensus that hospitalized patients with COVID should receive anticoagulants prophylactically, although the best dose is being studied,” said Judy Stone, MD, an infectious disease physician and journalist not involved in the study.
“This study extends those findings of benefit from anticoagulants to nonhospitalized patients, with fewer deaths in those treated with low-molecular-weight heparin,” Stone told Medscape Medical News. “The major limitation is that the study is retrospective and observational. The next step would be to confirm these findings prospectively, randomizing a similar group to LMWH or no anticoagulation.”
Another limitation of the study is that some of the patients lived in nursing homes and might have received care from nurses that eliminated the need for hospitalization, De Vito added.
The study did not note any external funding. The authors have disclosed no relevant financial relationships. Stone is a member of the Advisory Committee for C-Path CURE Drug Repurposing Collaboratory (CDRC) Program and has written for Medscape.
31st European Congress of Clinical Microbiology & Infectious Diseases (ECCMID): Abstract 1038. Presented July 9, 2021.
Tara Haelle is an independent science/health journalist based in Dallas.
