Oliynyk Oleksandr, Barg Wojciech, Slifirczyk Anna, Oliynyk Yanina, Dubrov Serhij, Gurianov Vitaliy, Rorat Marta
Department of Anaesthesiology and Intensive Care, Bogomolets National Medical University, 01601 Kyiv, Ukraine.
Department of Emergency Medicine, Pope John II State School of Higher Education in Biala Podlaska, 21-500 Biala Podlaska, Poland.
Life (Basel). 2021 Sep 30;11(10):1032. doi: 10.3390/life11101032.
COVID-19-associated coagulopathy (CAC) exacerbates the course of coronavirus infection and contributes to increased mortality. Current recommendations for CAC treatment include the use of low-molecular weight heparins (LMWH) at prophylactic or therapeutic doses, as well as the use of unfractionated heparin (UFH).
A randomised, controlled trial enrolled 126 patients hospitalised in the intensive care unit with severe COVID-19 complicated by CAC. The effects of LMWH at preventive and therapeutic doses and UFH at therapeutic doses on mortality and intubation rates were compared.
The number of intubations and deaths showed no significant difference depending on the anticoagulant therapy used. However, multivariate logistic regression models revealed an increased risk of intubation ( = 0.026, odds ratio (OR) = 3.33, 95% confidence interval (CI) 1.15-9.59), and an increased risk of death ( = 0.046, OR = 3.01, 95% CI 1.02-8.90), for patients treated with LMWH at a prophylactic dose but not at a therapeutic dose as compared to patients treated with UFH when controlling for other risk factors.
The use of unfractionated heparin in the treatment of COVID-19-associated coagulopathy seems to be more effective at reducing the risk of intubation and death than enoxaparin at prophylactic doses.
新型冠状病毒肺炎相关凝血病（CAC）会加重冠状病毒感染病程，并导致死亡率上升。目前针对CAC的治疗建议包括使用预防剂量或治疗剂量的低分子量肝素（LMWH），以及使用普通肝素（UFH）。
一项随机对照试验纳入了126例因重症新型冠状病毒肺炎合并CAC而入住重症监护病房的患者。比较了预防剂量和治疗剂量的LMWH以及治疗剂量的UFH对死亡率和插管率的影响。
根据所使用的抗凝治疗方法，插管和死亡人数无显著差异。然而，多因素逻辑回归模型显示，在控制其他风险因素时，与接受UFH治疗的患者相比，接受预防剂量而非治疗剂量LMWH治疗的患者插管风险增加（P = 0.026，比值比（OR） = 3.33，95%置信区间（CI）1.15 - 9.59），死亡风险增加（P = 0.046，OR = 3.01，95% CI 1.02 - 8.90）。
在治疗新型冠状病毒肺炎相关凝血病时，使用普通肝素似乎比使用预防剂量的依诺肝素在降低插管和死亡风险方面更有效。
