The association between treatment with heparin and survival in patients with Covid-19

Objectives

This study investigates the association between the treatment with heparin and mortality in patients admitted with Covid-19.

Methods

Routinely recorded, clinical data, up to the 24 ^th of April 2020, from the 2075 patients with Covid-19, admitted in 17 hospitals in Spain between the 1st of March and the 20th of April 2020 were used. The following variables were extracted for this study: age, gender, temperature, and saturation of oxygen on admission, treatment with heparin, hydroxychloroquine, azithromycin, steroids, tocilizumab, a combination of lopinavir with ritonavir, and oseltamivir, together with data on mortality. Multivariable logistic regression models were used to investigate the associations.

Results

At the time of collecting the data, 301 patients had died, 1447 had been discharged home from the hospitals, 201 were still admitted, and 126 had been transferred to hospitals not included in the study. Median follow up time was 8 (IQR:5-12) days. Heparin had been used in 1734 patients. Heparin was associated with lower mortality when the model was adjusted for age and gender, with OR (95%CI): 0.55 (0.37-0.82) p=0.003. This association remained significant when saturation of oxygen <90%, and temperature >37C were added to de model with OR: 0.54(0.36-0.82) p=0.003, and also when all the other drugs were included as covariates OR: 0.42 (0.26-0.66) p<0.001.

Conclusions

The association between heparin and lower mortality observed in this study can be acknowledged by clinicians in hospitals and in the community. Randomized controlled trials to assess the causal effects of heparin in different therapeutic regimes are required.

• <label>-</label>

  The administration of heparin was associated with lower mortality in patients admitted with Covid-19.

• <label>-</label>

  Our findings support that there is a thrombotic component in the development of respiratory distress for these patients.

• <label>-</label>

  The positive effect of heparin seems consistent and its use, when indicated, could be considered in clinical settings.

• <label>-</label>

  Randomized controlled trials are necessary to complement observational studies, and assess the causal associations between heparin, in different therapeutic regimes, and clinical outcomes.

• <label>-</label>

  Heparin is easy to administer, its use in ambulatory patients, to prevent admissions, or reduce their duration, could also be considered by clinicians and future researchers.