Coutureau Claire, Nguyen Philippe, Hentzien Maxime, Noujaim Peter Joe, Zerbib Sarah, Jolly Damien, Kanagaratnam Lukshe
Department of Research and Public Health, Reims University Hospital, 51092 Reims, France.
UR 3797 Vieillissement, Fragilité (VieFra), faculty of medicine, University of Reims Champagne-Ardenne, 51092 Reims, France.
Mediterr J Hematol Infect Dis. 2022 May 1;14(1):e2022036. doi: 10.4084/MJHID.2022.036. eCollection 2022.
Severe forms of SARS-CoV-2 infections are associated with high rates of thromboembolic complications. Professional societies and expert consensus reports have recommended anticoagulants for COVID-19 hospitalized patients. Our study aimed to compare the effect of therapeutic, intermediate and prophylactic doses of heparin on 6-week survival in patients hospitalized for COVID-19.
The study sample is a French cohort of COVID-19 patients hospitalized between Feb 25th and Apr 30th 2020. Patients were assigned to one of 3 anticoagulation dose groups based on the maximum dose they received for at least three days (prophylactic, intermediate or therapeutic). The main outcome was survival up to 42 days after hospital admission. Multivariate Cox regression models were performed to adjust analyses for confounding factors.
A total of 323 patients were included. The mean age of the study sample was 71.6 ± 15 years, and 56.3% were men. Treatment with the intermediate versus prophylactic dose of anticoagulation (HR = 0.50, 95%CI = [0.26; 0.99], p = 0.047) and with therapeutic versus prophylactic dose (HR = 0.58 95%CI = [0.34; 0.98], p = 0.044) was associated with a significant reduction in 6-week mortality, after adjustment for potential confounding factors. Comparison of therapeutic versus intermediate doses showed no significant difference in survival.
Our results reported a significant positive effect of intermediate and therapeutic doses of heparin on 6-week survival for hospitalized COVID-19 patients compared with a prophylactic dose.
严重的新型冠状病毒2型（SARS-CoV-2）感染与高血栓栓塞并发症发生率相关。专业协会和专家共识报告已推荐对住院的2019冠状病毒病（COVID-19）患者使用抗凝剂。我们的研究旨在比较治疗剂量、中等剂量和预防剂量的肝素对因COVID-19住院患者6周生存率的影响。
研究样本为2020年2月25日至4月30日期间在法国住院的COVID-19患者队列。根据患者至少接受三天的最大剂量，将其分配到3个抗凝剂量组之一（预防剂量组、中等剂量组或治疗剂量组）。主要结局是入院后42天的生存率。采用多变量Cox回归模型对混杂因素进行分析调整。
共纳入323例患者。研究样本的平均年龄为71.6±15岁，男性占56.3%。在对潜在混杂因素进行调整后，中等剂量与预防剂量抗凝治疗（风险比[HR]=0.50，95%置信区间[CI]=[0.26；0.99]，p=0.047）以及治疗剂量与预防剂量抗凝治疗（HR=0.58，95%CI=[0.34；0.98]，p=0.044）与6周死亡率显著降低相关。治疗剂量与中等剂量的比较显示生存率无显著差异。
我们的结果表明，与预防剂量相比，中等剂量和治疗剂量的肝素对住院COVID-19患者的6周生存率有显著的积极影响。
