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. 2020 May;18(5):1094-1099.
doi: 10.1111/jth.14817. Epub 2020 Apr 27.

Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy

Ning Tang  1 , Huan Bai  1 , Xing Chen  1 , Jiale Gong  1 , Dengju Li  2 , Ziyong Sun  1
Affiliations

Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy

Ning Tang et al. J Thromb Haemost. 2020 May.

Abstract

Background: A relatively high mortality of severe coronavirus disease 2019 (COVID-19) is worrying, and the application of heparin in COVID-19 has been recommended by some expert consensus because of the risk of disseminated intravascular coagulation and venous thromboembolism. However, its efficacy remains to be validated.

Methods: Coagulation results, medications, and outcomes of consecutive patients being classified as having severe COVID-19 in Tongji hospital were retrospectively analyzed. The 28-day mortality between heparin users and nonusers were compared, as was a different risk of coagulopathy, which was stratified by the sepsis-induced coagulopathy (SIC) score or D-dimer result.

Results: There were 449 patients with severe COVID-19 enrolled into the study, 99 of them received heparin (mainly with low molecular weight heparin) for 7 days or longer. D-dimer, prothrombin time, and age were positively, and platelet count was negatively, correlated with 28-day mortality in multivariate analysis. No difference in 28-day mortality was found between heparin users and nonusers (30.3% vs 29.7%, P = .910). But the 28-day mortality of heparin users was lower than nonusers in patients with SIC score ≥4 (40.0% vs 64.2%, P = .029), or D-dimer >6-fold of upper limit of normal (32.8% vs 52.4%, P = .017).

Conclusions: Anticoagulant therapy mainly with low molecular weight heparin appears to be associated with better prognosis in severe COVID-19 patients meeting SIC criteria or with markedly elevated D-dimer.

Keywords: D-dimer; coagulopathy; coronavirus disease 2019; low molecular weight heparin; sepsis.

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Figures

Figure 1
Figure 1
The enrollment of patients with severe COVID‐19
Figure 2
Figure 2
A paired bar chart showing the mortality between heparin users and nonusers in stratified patients. D‐D, D‐dimer; SIC+, SIC score ≥ 4; SIC−, SIC score < 4; ULN, upper limit of normal (0.5 μg/mL); a, P < .05 between heparin users and nonusers
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