6533b81ffe1ef96bd12772a4
RESEARCH PRODUCT
Heparin in COVID-19 patients is associated with reduced in-hospital mortality: the multicentre Italian CORIST Study
Walter AgenoRaffaele PesaventoMarinella AstutoKatleen De Gaetano DonatiFrancesca SantilliFilippo AucellaEleonora TaddeiMarianna MeschiariLaura ScorzoliniBiagio PincheraGiustino ParrutiLicia IacovielloAndrea VianelloGabriella GuarnieriArturo MontineriCrizia ColomboCarlo SignorelliLorenzo BlandiRaffaele De CaterinaMaria MussoFrancesco PetriStefano MaitanAnna OdoneLucia CaianoFrancesca CrostaLorenzo MarraGiuseppe PattiEmanuela PasiJovana MilicMarco OlivieriClaudia ColombaFrancesco Maria FuscoClaudia RavagliaAlexandra ViranoCarlo TortiSamir Al MoghaziVenerino PolettiRiccardo MaragnaCarlo SanroccoSandro MancarellaGreta BarbieriArturo CicculloLeonardo GrisafiPaola SimeoneLorenzo MenicantiAntonella PalimoddeGloria MaccagniAlessandra VergoriDaniela NiolaMarco G. MennuniGianpiero D'offiziClaudia MarottaDamiano D'ardesVincenzo SangiovanniPaolo BonfantiGiovanni LarizzaFrancesco Di GennaroAlessandro MengozziMassimo MapelliGiuseppe Di TanoLaura CarrozziAntonella AgodiFrancesco MenichettiMarialaura BonaccioAndrea AntinoriMarco VincetiMarco VincetiArmando LeoneFranco MastroianniSilvia MarongiuFilippo MinutoloGiulio MarescaBeatrice MolenaNausicaa BerselliFrancesco CipolloneMassimo FantoniAntonella CingolaniGiovanni GuaraldiRaffaella SgarigliaPiergiuseppe AgostoniAntonio CascioMaria MazzitelliRoberta ParisiAugusto Di CastelnuovoGian Battista DanziLuca AielloRoberto VettorElvira GrandoneLaura VoccianteEmauele GrazianiCristina MussiniMarianna RossiMarco RossatoRoberto CaudaRosa ArborettiAlessandro BartoloniSimona CostanzoFrancesco GianfagnaAndrea RognoniFerruccio MadaroRossella MarcucciPasquale AbeteFrancesco CacciatoreIvan Gentilesubject
Malemedicine.medical_specialtySettore MED/17 - Malattie Infettivecoronavirusheparin030204 cardiovascular system & hematologyLower risklaw.invention03 medical and health sciences0302 clinical medicineRandomized controlled triallawInternal medicineClinical endpointmedicineHumansThrombophilia030212 general & internal medicineHospital MortalityBlood CoagulationSurvival analysisAgedRetrospective Studiestreatmentbusiness.industryHeparinMortality rateCOVID-19mortalityLow-Molecular-WeightAnticoagulantsCOVID-19Retrospective cohort studyHeparinHematologyHeparin Low-Molecular-WeightMiddle AgedmortalitySurvival AnalysisCOVID-19 Drug Treatmentcoagulation activationcoronaviruItalytreatmentsPropensity score matchingcoagulation activation; coronavirus; COVID-19; heparin; mortality; treatmentsFemalecoagulation activation; coronavirus; COVID-19; heparin; mortality; treatments; Aged; Anticoagulants; Blood Coagulation; COVID-19; Female; Heparin; Heparin Low-Molecular-Weight; Hospital Mortality; Humans; Italy; Male; Middle Aged; Retrospective Studies; Survival Analysis; Thrombophiliabusinessmedicine.drugdescription
Abstract Introduction A hypercoagulable condition was described in patients with coronavirus disease 2019 (COVID-19) and proposed as a possible pathogenic mechanism contributing to disease progression and lethality. Aim We evaluated if in-hospital administration of heparin improved survival in a large cohort of Italian COVID-19 patients. Methods In a retrospective observational study, 2,574 unselected patients hospitalized in 30 clinical centers in Italy from February 19, 2020 to June 5, 2020 with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 infection were analyzed. The primary endpoint in a time-to event analysis was in-hospital death, comparing patients who received heparin (low-molecular-weight heparin [LMWH] or unfractionated heparin [UFH]) with patients who did not. We used multivariable Cox proportional-hazards regression models with inverse probability for treatment weighting by propensity scores. Results Out of 2,574 COVID-19 patients, 70.1% received heparin. LMWH was largely the most used formulation (99.5%). Death rates for patients receiving heparin or not were 7.4 and 14.0 per 1,000 person-days, respectively. After adjustment for propensity scores, we found a 40% lower risk of death in patients receiving heparin (hazard ratio = 0.60; 95% confidence interval: 0.49–0.74; E-value = 2.04). This association was particularly evident in patients with a higher severity of disease or strong coagulation activation. Conclusion In-hospital heparin treatment was associated with a lower mortality, particularly in severely ill COVID-19 patients and in those with strong coagulation activation. The results from randomized clinical trials are eagerly awaited to provide clear-cut recommendations.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2021-01-07 |