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Low Molecular Weight Heparin in Adults Inpatient COVID-19

18 Pages Posted: 1 Jun 2020

See all articles by Jose Ramon Gonzalez-Porras

Jose Ramon Gonzalez-Porras

University of Salamanca - Department of Hematology

Moncef Belhassen-Garcia

University of Salamanca - University Hospital of Salamanca

Amparo Lopez-Bernus

University of Salamanca - University Hospital of Salamanca

Luis Mario Vaquero-Roncero

University of Salamanca - University Hospital of Salamanca

Beatriz Rodriguez

University of Salamanca - University Hospital of Salamanca

Cristina Carbonell

University of Salamanca - University Hospital of Salamanca

Raul Azibeiro

University of Salamanca - Department of Hematology

Alberto Hernandez-Sanchez

University of Salamanca - Department of Hematology

Jose Ignacio Martin-Gonzalez

University of Salamanca - University Hospital of Salamanca

Juan Miguel Manrique

University of Salamanca - University Hospital of Salamanca

Gloria Alonso-Claudio

University of Salamanca - University Hospital of Salamanca; University of Salamanca - University Hospital of Salamanca

Felipe Alvarez-Navia

University of Salamanca - University Hospital of Salamanca

Jose Ignacio Madruga-Martin

University of Salamanca - University Hospital of Salamanca

Ronald Paul Macias-Casanova

University of Salamanca - University Hospital of Salamanca

Jorge García-Criado

University of Salamanca - University Hospital of Salamanca

Francisco Lozano

University of Salamanca - University Hospital of Salamanca

Jose Carlos Moyano

University of Salamanca - University Hospital of Salamanca

Miguel Vicente Sanchez-Hernandez

University of Salamanca - University Hospital of Salamanca

Víctor Sagredo-Meneses

University of Salamanca - University Hospital of Salamanca

Rafael Borras

University of Salamanca - University Hospital of Salamanca

Jose Maria Bastida

University Hospital of Salamanca-IBSAL - Department of Hematology

Guillermo Hernández-Pérez

University of Salamanca - University Hospital of Salamanca

Antonio Javier Chamorro

University of Salamanca - University Hospital of Salamanca

Miguel Marcos

Universidad de Salamanca - Internal Medicine Department

Jose Angel Martin-Oterino

University of Salamanca - University Hospital of Salamanca

More...

Abstract

Background: The intensity of thromboprophylaxis as potential factor related to in-patient mortality associated to COVID-19 remains unclear.  

Methods: This is a retrospective study to evaluate the effect of anticoagulation intensity in the in-patient mortality of unselected adults COVID-19. Patients were stratified according to the low molecular weight heparin (LMWH) regimen received: non-heparin, low-dose heparin (standard dose of prophylaxis) or high-dose heparin (dose higher than standard prophylaxis). 

Findings: 690 patients were included and the median age was 72 years. Heparin was administered to 611 patients from hospital admission (88·6%). 422 patients (61·2%) were in the low-dose group and 189 patients (27·4%) in the high-dose group. The overall inpatient mortality rate was 28·7%. The adjusted risk for in-patient mortality in the non-heparin group was 6·2‐fold higher (OR 6·2, 95% CI: 2·6–14.6) compared with the high-heparin group and receiving low-dose heparin increased the risk for in-patient mortality 2·0-fold (OR 2·0, 95% CI: 1·1–3.6) compared with the high-dose group. The age, underlying disease, LDH levels and the - disseminated intravascular coagulation of International Society of Thrombosis and Hemostasis (DIC-ISTH) score on admission were also independently associated with inpatient mortality rate. Concerning safety, 24 patients (3·4%) experienced major hemorrhage (fatal in 1) and 14 of them were receiving high-dose heparin. By contrast, 18 patients (2·6%) developed an episode of thromboembolism (fatal in 3). 

Interpretation: LMWH at the time of admission significantly reduced the mortality in unselected adults inpatient COVID-19 and the magnitude of the benefit was greater for the high-dose heparin subgroup. As the major bleeding rate was also higher in this group, the risk/benefit should be individualized. 

Funding Statement:  None

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: This study was conducted according to the Declaration of Helsinki and approved by the Ethics Committee of University Hospital of Salamanca (Code: CEIm PI2020-04-472).

Keywords: COVID-19; coagulopathy; disseminated intravascular coagulation; low-weight molecular heparin

Suggested Citation

Gonzalez-Porras, Jose Ramon and Belhassen-Garcia, Moncef and Lopez-Bernus, Amparo and Vaquero-Roncero, Luis Mario and Rodriguez, Beatriz and Carbonell, Cristina and Azibeiro, Raul and Hernandez-Sanchez, Alberto and Martin-Gonzalez, Jose Ignacio and Miguel Manrique, Juan and Alonso-Claudio, Gloria and Alvarez-Navia, Felipe and Madruga-Martin, Jose Ignacio and Macias-Casanova, Ronald Paul and García-Criado, Jorge and Lozano, Francisco and Moyano, Jose Carlos and Sanchez-Hernandez, Miguel Vicente and Sagredo-Meneses, Víctor and Borras, Rafael and Bastida, Jose Maria and Hernández-Pérez, Guillermo and Chamorro, Antonio Javier and Marcos, Miguel and Martin-Oterino, Jose Angel, Low Molecular Weight Heparin in Adults Inpatient COVID-19 (4/22/2020). Available at SSRN: https://ssrn.com/abstract=3586665 or http://dx.doi.org/10.2139/ssrn.3586665

Jose Ramon Gonzalez-Porras

University of Salamanca - Department of Hematology

Paseo de San Vicente, s/n
Salamanca, 37007
Spain

Moncef Belhassen-Garcia

University of Salamanca - University Hospital of Salamanca

Salamanca
Spain

Amparo Lopez-Bernus

University of Salamanca - University Hospital of Salamanca

Salamanca
Spain

Luis Mario Vaquero-Roncero

University of Salamanca - University Hospital of Salamanca

Salamanca
Spain

Beatriz Rodriguez

University of Salamanca - University Hospital of Salamanca

Salamanca
Spain

Cristina Carbonell

University of Salamanca - University Hospital of Salamanca

Salamanca
Spain

Raul Azibeiro

University of Salamanca - Department of Hematology

Paseo de San Vicente, s/n
Salamanca, 37007
Spain

Alberto Hernandez-Sanchez

University of Salamanca - Department of Hematology

Paseo de San Vicente, s/n
Salamanca, 37007
Spain

Jose Ignacio Martin-Gonzalez

University of Salamanca - University Hospital of Salamanca

Salamanca
Spain

Juan Miguel Manrique

University of Salamanca - University Hospital of Salamanca

Salamanca
Spain

Gloria Alonso-Claudio

University of Salamanca - University Hospital of Salamanca

Salamanca
Spain

University of Salamanca - University Hospital of Salamanca

Salamanca
Spain

Felipe Alvarez-Navia

University of Salamanca - University Hospital of Salamanca

Salamanca
Spain

Jose Ignacio Madruga-Martin

University of Salamanca - University Hospital of Salamanca

Salamanca
Spain

Ronald Paul Macias-Casanova

University of Salamanca - University Hospital of Salamanca

Salamanca
Spain

Jorge García-Criado

University of Salamanca - University Hospital of Salamanca

Salamanca
Spain

Francisco Lozano

University of Salamanca - University Hospital of Salamanca

Salamanca
Spain

Jose Carlos Moyano

University of Salamanca - University Hospital of Salamanca

Salamanca
Spain

Miguel Vicente Sanchez-Hernandez

University of Salamanca - University Hospital of Salamanca

Salamanca
Spain

Víctor Sagredo-Meneses

University of Salamanca - University Hospital of Salamanca

Salamanca
Spain

Rafael Borras

University of Salamanca - University Hospital of Salamanca

Salamanca
Spain

Jose Maria Bastida (Contact Author)

University Hospital of Salamanca-IBSAL - Department of Hematology ( email )

Paseo de San Vicente, s/n
Salamanca, 37007
Spain

Guillermo Hernández-Pérez

University of Salamanca - University Hospital of Salamanca

Salamanca
Spain

Antonio Javier Chamorro

University of Salamanca - University Hospital of Salamanca

Salamanca
Spain

Miguel Marcos

Universidad de Salamanca - Internal Medicine Department

Salamanca
Spain

Jose Angel Martin-Oterino

University of Salamanca - University Hospital of Salamanca

Salamanca
Spain

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