Disease Control and Prevention Center, National Center for Global Health and Medicine.
Department of Emergency and Critical Care Medicine, Fukushima Medical University.
J Atheroscler Thromb. 2024 Aug 1;31(8):1179-1193. doi: 10.5551/jat.64448. Epub 2024 Feb 14.
Several studies have shown the efficacy and safety of low-molecular-weight heparin use in coronavirus disease 2019 (COVID-19), but that of unfractionated heparin (UFH) has not been investigated. We investigated the prevalence of bleeding complications during UFH administration, its impact on mortality, and the risk factors of bleeding outcomes associated with UFH.
This retrospective cohort study was conducted at a single-center tertiary care hospital, including hospitalized patients with COVID-19. The primary outcomes were measured as the prevalence of bleeding complications during hospitalization, and the secondary outcomes were thromboembolic events and 60-day mortality rates. Logistic regression analysis and propensity score matching were used to assess risk factors for bleeding complications and their impact on mortality.
Among 1035 included patients, 516 patients were treated with UFH. Twelve (2.3%) patients in the UFH group experienced major bleeding. The prevalence of major bleeding in patients treated with therapeutic-dose UFH was 9.2%. Logistic regression analysis showed that age ≥ 60 years (adjusted odds ratio [aOR], 3.89; 95% confidence interval [CI], 1.01-15.0; P＜.05) and COVID-19 severity (aOR, 35.9; 95% CI, 4.57-282; P＜.05) were associated with major bleeding complications. After propensity score matching, 11 major and 11 non-major bleeding cases (including minor bleeding) were matched. The 60-day cumulative mortality rate between the two groups did not differ significantly (P=.13, log-rank test).
The incidence of major bleeding in COVID-19 patients using therapeutic-dose UFH was relatively high. Critical COVID-19 and older age were risk factors for bleeding complications.
多项研究表明，低分子肝素在 2019 年冠状病毒病（COVID-19）中的疗效和安全性，但未研究普通肝素（UFH）。我们调查了 UFH 给药期间出血并发症的发生率、对死亡率的影响以及与 UFH 相关的出血结局的危险因素。
这项回顾性队列研究在一家单中心三级保健医院进行，包括 COVID-19 住院患者。主要结局指标为住院期间出血并发症的发生率，次要结局指标为血栓栓塞事件和 60 天死亡率。使用逻辑回归分析和倾向评分匹配来评估出血并发症的危险因素及其对死亡率的影响。
在纳入的 1035 名患者中，516 名患者接受 UFH 治疗。UFH 组中有 12 名（2.3%）患者发生大出血。接受治疗剂量 UFH 治疗的患者大出血的发生率为 9.2%。逻辑回归分析显示，年龄≥60 岁（调整优势比[aOR]，3.89；95%置信区间[CI]，1.01-15.0；P＜0.05）和 COVID-19 严重程度（aOR，35.9；95% CI，4.57-282；P＜0.05）与大出血并发症相关。经过倾向评分匹配后，匹配了 11 例大出血和 11 例非大出血病例（包括轻度出血）。两组 60 天累积死亡率无显著差异（P=.13，对数秩检验）。
COVID-19 患者使用治疗剂量 UFH 时，大出血的发生率相对较高。重症 COVID-19 和年龄较大是出血并发症的危险因素。
