Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia

Abstract Prophylactic low molecular weight heparin (pLMWH) is currently recommended in COVID-19 to reduce the risk of coagulopathy. The aim of this study was to evaluate whether the antinflammatory effects of pLMWH could translate in lower rate of clinical progression in patients with COVID-19 pneum...

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Autores principales:	Alessandra Vergori, Patrizia Lorenzini, Alessandro Cozzi-Lepri, Davide Roberto Donno, Gina Gualano, Emanuele Nicastri, Fabio Iacomi, Luisa Marchioni, Paolo Campioni, Vincenzo Schininà, Stefania Cicalini, Chiara Agrati, Maria Rosaria Capobianchi, Enrico Girardi, Giuseppe Ippolito, Francesco Vaia, Nicola Petrosillo, Andrea Antinori, Fabrizio Taglietti, The ReCOVeRI Study Group
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/2995fcd124704c10bbc936812be72ab7
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spelling	oai:doaj.org-article:2995fcd124704c10bbc936812be72ab72021-12-02T18:24:54ZProphylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia10.1038/s41598-021-90713-62045-2322https://doaj.org/article/2995fcd124704c10bbc936812be72ab72021-05-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-90713-6https://doaj.org/toc/2045-2322Abstract Prophylactic low molecular weight heparin (pLMWH) is currently recommended in COVID-19 to reduce the risk of coagulopathy. The aim of this study was to evaluate whether the antinflammatory effects of pLMWH could translate in lower rate of clinical progression in patients with COVID-19 pneumonia. Patients admitted to a COVID-hospital in Rome with SARS-CoV-2 infection and mild/moderate pneumonia were retrospectively evaluated. The primary endpoint was the time from hospital admission to orotracheal intubation/death (OTI/death). A total of 449 patients were included: 39% female, median age 63 (IQR, 50–77) years. The estimated probability of OTI/death for patients receiving pLMWH was: 9.5% (95% CI 3.2–26.4) by day 20 in those not receiving pLMWH vs. 10.4% (6.7–15.9) in those exposed to pLMWH; p-value = 0.144. This risk associated with the use of pLMWH appeared to vary by PaO2/FiO2 ratio: aHR 1.40 (95% CI 0.51–3.79) for patients with an admission PaO2/FiO2 ≤ 300 mmHg and 0.27 (0.03–2.18) for those with PaO2/FiO2 > 300 mmHg; p-value at interaction test 0.16. pLMWH does not seem to reduce the risk of OTI/death mild/moderate COVID-19 pneumonia, especially when respiratory function had already significantly deteriorated. Data from clinical trials comparing the effect of prophylactic vs. therapeutic dosage of LMWH at various stages of COVID-19 disease are needed.Alessandra VergoriPatrizia LorenziniAlessandro Cozzi-LepriDavide Roberto DonnoGina GualanoEmanuele NicastriFabio IacomiLuisa MarchioniPaolo CampioniVincenzo SchininàStefania CicaliniChiara AgratiMaria Rosaria CapobianchiEnrico GirardiGiuseppe IppolitoFrancesco VaiaNicola PetrosilloAndrea AntinoriFabrizio TagliettiThe ReCOVeRI Study GroupNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Alessandra Vergori Patrizia Lorenzini Alessandro Cozzi-Lepri Davide Roberto Donno Gina Gualano Emanuele Nicastri Fabio Iacomi Luisa Marchioni Paolo Campioni Vincenzo Schininà Stefania Cicalini Chiara Agrati Maria Rosaria Capobianchi Enrico Girardi Giuseppe Ippolito Francesco Vaia Nicola Petrosillo Andrea Antinori Fabrizio Taglietti The ReCOVeRI Study Group Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia
description	Abstract Prophylactic low molecular weight heparin (pLMWH) is currently recommended in COVID-19 to reduce the risk of coagulopathy. The aim of this study was to evaluate whether the antinflammatory effects of pLMWH could translate in lower rate of clinical progression in patients with COVID-19 pneumonia. Patients admitted to a COVID-hospital in Rome with SARS-CoV-2 infection and mild/moderate pneumonia were retrospectively evaluated. The primary endpoint was the time from hospital admission to orotracheal intubation/death (OTI/death). A total of 449 patients were included: 39% female, median age 63 (IQR, 50–77) years. The estimated probability of OTI/death for patients receiving pLMWH was: 9.5% (95% CI 3.2–26.4) by day 20 in those not receiving pLMWH vs. 10.4% (6.7–15.9) in those exposed to pLMWH; p-value = 0.144. This risk associated with the use of pLMWH appeared to vary by PaO2/FiO2 ratio: aHR 1.40 (95% CI 0.51–3.79) for patients with an admission PaO2/FiO2 ≤ 300 mmHg and 0.27 (0.03–2.18) for those with PaO2/FiO2 > 300 mmHg; p-value at interaction test 0.16. pLMWH does not seem to reduce the risk of OTI/death mild/moderate COVID-19 pneumonia, especially when respiratory function had already significantly deteriorated. Data from clinical trials comparing the effect of prophylactic vs. therapeutic dosage of LMWH at various stages of COVID-19 disease are needed.
format	article
author	Alessandra Vergori Patrizia Lorenzini Alessandro Cozzi-Lepri Davide Roberto Donno Gina Gualano Emanuele Nicastri Fabio Iacomi Luisa Marchioni Paolo Campioni Vincenzo Schininà Stefania Cicalini Chiara Agrati Maria Rosaria Capobianchi Enrico Girardi Giuseppe Ippolito Francesco Vaia Nicola Petrosillo Andrea Antinori Fabrizio Taglietti The ReCOVeRI Study Group
author_facet	Alessandra Vergori Patrizia Lorenzini Alessandro Cozzi-Lepri Davide Roberto Donno Gina Gualano Emanuele Nicastri Fabio Iacomi Luisa Marchioni Paolo Campioni Vincenzo Schininà Stefania Cicalini Chiara Agrati Maria Rosaria Capobianchi Enrico Girardi Giuseppe Ippolito Francesco Vaia Nicola Petrosillo Andrea Antinori Fabrizio Taglietti The ReCOVeRI Study Group
author_sort	Alessandra Vergori
title	Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia
title_short	Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia
title_full	Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia
title_fullStr	Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia
title_full_unstemmed	Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia
title_sort	prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate covid-19 pneumonia
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/2995fcd124704c10bbc936812be72ab7
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Prophylactic heparin and risk of orotracheal intubation or death in patients with mild or moderate COVID-19 pneumonia

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