Heparin in COVID-19 Patients Is Associated with Reduced In-Hospital Mortality: The Multicenter Italian CORIST Study.
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Di Castelnuovo Augusto, Costanzo Simona, Antinori Andrea, Berselli Nausicaa, Blandi Lorenzo, Bonaccio Marialaura, Cauda Roberto, Guaraldi Giovanni, Menicanti Lorenzo, Mennuni Marco, Parruti Giustino, Patti Giuseppe, Santilli Francesca, Signorelli Carlo, Vergori Alessandra, Abete Pasquale, Ageno Walter, Agodi Antonella, Agostoni Piergiuseppe, Aiello Luca, Al Moghazi Samir, Arboretti Rosa, Astuto Marinella, Aucella Filippo, Barbieri Greta, Bartoloni Alessandro, Bonfanti Paolo, Cacciatore Francesco, Caiano Lucia, Carrozzi Laura, Cascio Antonio, Ciccullo Arturo, Cingolani Antonella, Cipollone Francesco, Colomba Claudia, Colombo Crizia, Crosta Francesca, Danzi Gian Battista, D'Ardes Damiano, de Gaetano Donati Katleen, Di Gennaro Francesco, Di Tano Giuseppe, D'Offizi Gianpiero, Fantoni Massimo, Fusco Francesco Maria, Gentile Ivan, Gianfagna Francesco, Grandone Elvira, Graziani Emauele, Grisafi Leonardo, Guarnieri Gabriella, Larizza Giovanni, Leone Armando, Maccagni Gloria, Madaro Ferruccio, Maitan Stefano, Mancarella Sandro, Mapelli Massimo, Maragna Riccardo, Marcucci Rossella, Maresca Giulio, Marongiu Silvia, Marotta Claudia, Marra Lorenzo, Mastroianni Franco, Mazzitelli Maria, Mengozzi Alessandro, Menichetti Francesco, Meschiari Marianna, Milic Jovana, Minutolo Filippo, Molena Beatrice, Montineri Arturo, Mussini Cristina, Musso Maria, Niola Daniela, Odone Anna, Olivieri Marco, Palimodde Antonella, Parisi Roberta, Pasi Emanuela, Pesavento Raffaele, Petri Francesco, Pinchera Biagio, Poletti Venerino, Ravaglia Claudia, Rognoni Andrea, Rossato Marco, Rossi Marianna, Sangiovanni Vincenzo, Sanrocco Carlo, Scorzolini Laura, Sgariglia Raffaella, Simeone Paola Giustina, Taddei Eleonora, Torti Carlo, Vettor Roberto, Vianello Andrea, Vinceti Marco, Virano Alexandra, Vocciante Laura, De Caterina Raffaele, Iacoviello Licia
Аннотация
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.