| Autor: |
Carlos Eduardo Pompilio, Sabrena Tangri, Deepa Suryanarayan, Cynthia Wu, Hassan Rahhal, Karine Doyon, Fionnuala Ní Áinle, Paula D. James, Kevin E. Thorpe, Fei Zuo, Catherine Sperlich, David Lillicrap, Marc Carrier, Christos Colovos, Michael Fralick, E. Roseann Andreou, Terence Tang, Elnara Marcia Negri, Grace H. Tang, Gloria Lim, Rapid Trial investigators, Agnes Y.Y. Lee, Mozah Obaid Almarshoodi, Vera Dounaevskaia, Jai Jayakar, Fahad AlSumait, Marie-Pier Arsenault, Michelle Sholzberg, Mohammed AlSheef, Eric Tseng, Khalid Alayed, Peter J. Jaksa, Bruno R. da Costa, Saskia Middeldorp, Faris Alomran, Andrew Beckett, Musaad AlHamzah, Lisa Baumann Kreuziger, Mary Cushman, Lana A Castellucci, Peter Jüni |
| Jazyk: |
angličtina |
| Rok vydání: |
2021 |
| Předmět: |
|
| Zdroj: |
medRxiv |
| Popis: |
BackgroundHeparin, in addition to its anticoagulant properties, has anti-inflammatory and potential anti-viral effects, and may improve endothelial function in patients with Covid-19. Early initiation of therapeutic heparin could decrease the thrombo-inflammatory process, and reduce the risk of critical illness or death.MethodsWe randomly assigned moderately ill hospitalized ward patients admitted for Covid-19 with elevated D-dimer level to therapeutic or prophylactic heparin. The primary outcome was a composite of death, invasive mechanical ventilation, non-invasive mechanical ventilation or ICU admission. Safety outcomes included major bleeding. Analysis was by intention-to-treat.ResultsAt 28 days, the primary composite outcome occurred in 37 of 228 patients (16.2%) assigned to therapeutic heparin, and 52 of 237 patients (21.9%) assigned to prophylactic heparin (odds ratio, 0.69; 95% confidence interval [CI], 0.43 to 1.10; p=0.12). Four patients (1.8%) assigned to therapeutic heparin died compared with 18 patients (7.6%) assigned to prophylactic heparin (odds ratio, 0.22; 95%-CI, 0.07 to 0.65). The composite of all-cause mortality or any mechanical ventilation occurred in 23 (10.1%) in the therapeutic heparin group and 38 (16.0%) in the prophylactic heparin group (odds ratio, 0.59; 95%-CI, 0.34 to 1.02). Major bleeding occurred in 2 patients (0.9%) with therapeutic heparin and 4 patients (1.7%) with prophylactic heparin (odds ratio, 0.52; 95%-CI, 0.09 to 2.85).ConclusionsIn moderately ill ward patients with Covid-19 and elevated D-dimer level, therapeutic heparin did not significantly reduce the primary outcome but decreased the odds of death at 28 days.Trial registration numbers: NCT04362085; NCT04444700 |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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