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The authors of this retrospective analysis evaluated the 28-day mortality rate in 449 patients with COVID-19 infection treated with or without anticoagulation and stratified by sepsis-induced coagulopathy or D-dimer. Overall, 22% of patients received anticoagulation. There was no significant difference in 28-day mortality between those treated with anticoagulation and those not (30.3% vs 29.7%; P=.91); however, when stratified by the ISTH sepsis-induced coagulopathy score of ≥4, patients treated with anticoagulation had a significant reduction in mortality compared with those not receiving anticoagulation (40% vs 64.2%; P=.029).
Among patients with an ISTH sepsis-induced coagulopathy score of ≥4, the use of prophylactic-dose anticoagulation resulted in a lower mortality rate compared with no anticoagulation. Patients with a higher D-dimer and lower platelet count had higher rates of mortality, likely related to sepsis-associated DIC, which has previously been shown to be associated with poor outcomes in patients with COVID-19 infection.
– Curtis Lachowiez, MD
This abstract is available on the publisher's site.
A relatively high mortality of severe coronavirus disease 2019 (COVID-19) is worrying, the application of heparin in COVID-19 has been recommended by some expert consensus due to the risk of disseminated intravascular coagulation and venous thromboembolism. However, its efficacy remains to be validated.
Coagulation results, medications and outcomes of consecutive patients being classified as severe COVID-19 in Tongji hospital were retrospectively analysed. The 28-day mortality between heparin users and nonusers were compared, also in different risk of coagulopaphy which was stratified by the sepsis-induced coagulopathy (SIC) score or D-dimer result.
There were 449 patients with severe COVID-19 enrolled into the study, 99 of them received heparin (mainly with low molecular weight heparin, LMWH) for 7 days or longer. The D-dimer, prothrombin time and age were positively, and platelet count was negatively, correlated with 28-day mortality in multivariate analysis. No difference on 28-day mortality was found between heparin users and nonusers (30.3% vs 29.7%, P=0.910). But the 28-day mortality of heparin users were lower than nonusers In patients with SIC score ≥4 (40.0% vs 64.2%, P=0.029), or D-dimer > 6 fold of upper limit of normal (32.8% vs 52.4%, P=0.017).
Anticoagulant therapy mainly with LMWH appears to be associated with better prognosis in severe COVID-19 patients meeting SIC criteria or with markedly elevated D-dimer.