Heparin in COVID-19 Patients Is Associated with Reduced In-Hospital Mortality: The Multicenter Italian CORIST Study
- Authors: Di Castelnuovo A.; Costanzo S.; Antinori A.; Berselli N.; Blandi L.; Bonaccio M.; Cauda R.; Guaraldi G.; Menicanti L.; Mennuni M.; Parruti G.; Patti G.; Santilli F.; Signorelli C.; Vergori A.; Abete P.; Ageno W.; Agodi A.; Agostoni P.; Aiello L.; Al Moghazi S.; Arboretti R.; Astuto M.; Aucella F.; Barbieri G.; Bartoloni A.; Bonfanti P.; Cacciatore F.; Caiano L.; Carrozzi L.; Cascio A.; Ciccullo A.; Cingolani A.; Cipollone F.; Colomba C.; Colombo C.; Crosta F.; Danzi G.B.; D'Ardes D.; De Gaetano Donati K.; Di Gennaro F.; Di Tano G.; D'Offizi G.; Fantoni M.; Fusco F.M.; Gentile I.; Gianfagna F.; Grandone E.; Graziani E.; Grisafi L.; Guarnieri G.; Larizza G.; Leone A.; MacCagni G.; Madaro F.; Maitan S.; Mancarella S.; Mapelli M.; Maragna R.; Marcucci R.; Maresca G.; Marongiu S.; Marotta C.; Marra L.; Mastroianni F.; Mazzitelli M.; Mengozzi A.; Menichetti F.; Meschiari M.; Milic J.; Minutolo F.; Molena B.; Montineri A.; Mussini C.; Musso M.; Niola D.; Odone A.; Olivieri M.; Palimodde A.; Parisi R.; Pasi E.; Pesavento R.; Petri F.; Pinchera B.; Poletti V.; Ravaglia C.; Rognoni A.; Rossato M.; Rossi M.; Sangiovanni V.; Sanrocco C.; Scorzolini L.; Sgariglia R.; Simeone P.G.; Taddei E.; Torti C.; Vettor R.; Vianello A.; Vinceti M.; Virano A.; Vocciante L.; De Caterina R.; Iacoviello L.
- Publication year: 2021
- Type: Articolo in rivista
- OA Link: http://hdl.handle.net/10447/534428
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.