DTA

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Tesi etd-11112020-174439

Type of thesis
Corsi integrativi
Author
GALFO, VALENTINA
URN
etd-11112020-174439
Title
Role of low-molecular weight heparin in hospitalized patients with SARS-CoV-2 pneumonia: a prospective observational study
Structure
Cl. Sc. Sperimentali - Medicina
Course
SCIENZE MEDICHE - SCIENZE MEDICHE
Committee
Tutor Prof. RECCHIA, FABIO ANASTASIO
Relatore Prof. MENICHETTI, FRANCESCO
Relatore Prof. FALCONE, MARCO
Presidente Prof. EMDIN, MICHELE
Membro Prof. COCEANI, FLAVIO
Membro Prof. LIONETTI, VINCENZO
Membro Prof. PASSINO, CLAUDIO
Membro Dott.ssa ANGELONI, DEBORA
Membro Dott. MEOLA, MARIO
Membro Dott.ssa PETRUCCI, ILARIA
Membro Dott. GIANNONI, ALBERTO
Keywords
  • LMWH; Heparin
  • Mortality; COVID-19
Exam session start date
14/12/2020;
Availability
parziale
Abstract
The objective of this study is to evaluate the impact of low molecular weight heparin (LMWH) on the outcome of patients with SARS-CoV-2 pneumonia.<br>It is a prospective observational study including consecutive patients with laboratory confirmed<br>SARS-CoV-2 pneumonia admitted to the University Hospital of Pisa (4th March-30th 76 April 2020).<br>Demographic, clinical, and outcome data were collected. The primary endpoint was 30-day mortality. The secondary endpoint was a composite of death or severe ARDS. LMWH, hydroxychloroquine, doxycycline, macrolides, antiretrovirals, remdesivir, baricitinib, tocilizumab, and steroids were evaluated as treatment exposures of interest. First, a Cox-regression analysis, in which treatments were introduced as time-dependent variables, was performed to evaluate the association of exposures and outcomes. Then, a time-dependent Propensity-score (PS) was calculated and a PS-matching performed for each treatment variable. <br><br>Among 315 patients with SARS-CoV-2 pneumonia, 70 (22.2%) died during hospital stay.<br>The composite endpoint was achieved by 114 (36.2%) patients. Overall, 244 (77.5%) patients received LMWH, 238 (75.5%) hydroxychloroquine, 201 (63.8%) proteases inhibitors, 150 (47.6%) doxycycline, 141 (44.8%) steroids, 42 (13.3%) macrolides, 40 (12.7%) baricitinib, 13 (4.1%) tocilizumab, and 13 (4.1%) remdesivir. At multivariate analysis, LMWH was associated with a reduced risk of 30-day mortality (HR 0.36 [95% CI 0.21-0.6], p&lt;0.001) and composite endpoint (HR 0.61 [95% CI 0.39-0.95], p=0.029). The PS-matched cohort of 55 couples confirmed the same results for both primary and secondary endpoint.<br><br>This study suggests that LMWH might reduce the risk of in-hospital mortality and severe ARDS in Covid-19. Randomized controlled trials are warranted to confirm these preliminary findings
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