Mediterranea Cardiocentro, Napoli, Italy.
Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, Italy.
Thromb Haemost. 2021 Aug;121(8):1054-1065. doi: 10.1055/a-1347-6070. Epub 2021 Feb 28.
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.
We evaluated if in-hospital administration of heparin improved survival in a large cohort of Italian COVID-19 patients.
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.
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.
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.
新冠肺炎（COVID-19）患者存在高凝状态，这被认为是导致疾病进展和致死的可能发病机制之一。
我们评估了在意大利 COVID-19 患者的大型队列中，住院期间使用肝素是否可以改善生存率。
在一项回顾性观察性研究中，分析了 2020 年 2 月 19 日至 2020 年 6 月 5 日期间在意大利 30 个临床中心住院的 2574 例未选择的实验室确诊的严重急性呼吸综合征冠状病毒 2 感染患者。事件时间分析的主要终点是院内死亡，比较接受肝素（低分子量肝素[LMWH]或未分级肝素[UFH]）与未接受肝素的患者。我们使用倾向评分逆概率治疗加权的多变量 Cox 比例风险回归模型。
在 2574 例 COVID-19 患者中，70.1%接受了肝素。LMWH 是最常用的制剂（99.5%）。接受肝素或不接受肝素的患者的死亡率分别为每 1000 人天 7.4 和 14.0 例。在调整倾向评分后，我们发现接受肝素的患者死亡风险降低了 40%（风险比=0.60；95%置信区间：0.49-0.74；E 值=2.04）。这种关联在疾病严重程度较高或强烈凝血激活的患者中更为明显。
住院期间使用肝素与死亡率降低相关，尤其是在重症 COVID-19 患者和强烈凝血激活的患者中。迫切需要随机临床试验的结果来提供明确的建议。
