Early Heparin Treatment Linked to Lower COVID-19 Mortality
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Early treatment with low-molecular-weight heparin (LMWH) reduces the risk for death in patients with COVID-19, a retrospective cohort study shows.
Heparin could reduce the risk for blood clots, said Andrea De Vito, MD, from the Unit of Infectious Diseases at the University of Sassari, Sassari, Italy, during his online presentation of the findings at the 31st European Congress of Clinical Microbiology & Infectious Diseases.
“Several studies try to describe the role played by coagulopathies in COVID-19 death,” but the mechanism causing them is still unclear, De Vito explained.
Some guidelines have suggested heparin as a treatment for hospitalized COVID patients, but few have looked at nonhospitalized patients. In fact, the National Institutes of Health discourages the use of heparin in nonhospitalized COVID patients, and guidance for the home care of COVID patients from the World Health Organization doesn’t mention heparin treatment at all, he said.
To examine the benefits of early heparin — whether administered at home or in the hospital — De Vito and his colleagues looked at a cohort of older adults with COVID who were evaluated or treated at an Italian university hospital.
“Some patients were hospitalized immediately after symptoms onset; other people preferred to call their general practitioner and started the treatment at home,” De Vito told Medscape Medical News. “Other people were hospitalized for worsening of symptoms later in the course of the disease.”
Of the 734 patients, 296 received heparin within 5 days of the onset of symptoms or a positive COVID test. Of the remaining 438 patients, 196 received LMWH treatment later during the disease course, and the rest never received LMWH.
All patients who received early heparin were treated with LMWH 4000 IU, or 6000 IU if their body mass index (BMI) was above 30 kg/m2. This was reduced to 2000 IU if estimated glomerular filtration rate (eGFR) dropped below 30 mL/min. None of the patients had previously received heparin.
Median age was slightly younger for patients who received early heparin than for those who did not (76.8 vs 78.5 years).
Other demographic characteristics, such as sex and BMI, were similar in the two groups, as were rates of comorbidities, such as hypertension, cardiovascular disease, diabetes, COPD, kidney disease, and neurologic conditions. Also similar were the frequency of symptoms (such as fever, cough, and shortness of breath) and rates of treatment with remdesivir or steroids.
Rates of hospital admission were not significantly different between patients who received early heparin and those who did not (65% vs 61%). There was also no significant difference in use of a Venturi mask (35% vs 28%), noninvasive ventilation (13% vs 14%), or intubation (5% vs 8%).
However, rates of death were significantly lower in patients who received early heparin than in those 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.
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