Treating COVID-19-Associated Coagulopathy: Unfractionated vs LMW Heparin

Among hospitalized patients with confirmed COVID-19, those who receive unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) demonstrate a significant decrease in D-dimer values, which suggests that both agents are similarly effective in the treatment of coagulopathy. These were among study findings recently published in Annals of Medicine and Surgery (London).

Patients who are critically ill with COVID-19 have a high reported incidence of thrombotic complications, which often result in poor clinical outcomes, noted investigators for the current study. Several studies have reported that coagulopathic complications are common among individuals with severe COVID-19, with the disease known to predispose patients to both venous and arterial thromboembolic disease. Indications of disease severity and establishment of coagulopathy vary, including elevated D-dimer levels, thrombocytopenia, and prolonged prothrombin time and activated partial thromboplastin clotting time (aPTT).

In the current study, investigators sought to compare the effectiveness of UFH with that of LMWH (fondaparinux) in hospitalized patients with COVID-19 who exhibited hypercoagulable complications. An observational study was conducted at the Islamic Hospital Jakarta Sukapura in North Jakarta, Indonesia, between August 2020 and August 2021. The research design used in this analysis was a retrospective cohort approach that incorporated pretests and posttests via secondary data obtained from the medical records of inpatients from the Indonesian hospital with a confirmed COVID-19 diagnosis. Most of the inpatients who had confirmed diagnoses of COVID-19 were between 50 and 59 years of age and were women.

A total of 98 patients were evaluated, 35 of whom were treated with UFH and 63 of whom were treated with LMWH. Overall, 52% of the participants were women and 30.6% of them were more than 60 years of age. The investigators compared patient D-dimer values following UFH administration and following LMWH administration.

Study authors observed no significant differences in level of increase or decrease in D-dimer values between the 2 groups (P =.193 and P >.05, respectively), thus demonstrating no significant association between aPTT values and patient status.

The greatest reductions in D-dimer value (0.01±0.5 g fibrinogen equivalent unit /mL) were reported among 34.3% (12 of 35) of participants in the UFH group vs 23.8% (15 of 63) of those in the LMWH group.

A key limitation of the current study is the fact that some of the participants may have had incomplete data, given that not all inpatients with confirmed COVID-19 undergo a thorough coagulation examination prior to and following administration of UFH and LMWH.

The investigators concluded that “There was a tendency toward increased D-dimer, normal prothrombin time, normal activated partial thromboplastin clotting time, and increased fibrinogen values in each COVID-19 patient. The results demonstrated

a significant relationship between the D-dimer and prothrombin time parameter in confirmed COVID-19 inpatients.”

Reference

Fachri M, Hatta M, Tarigan SNNA, et al. Heparin for patients with coronavirus disease 2019 and hypercoagulation complications: a cohort study. Ann Med Surg (Lond). Published online June 28, 2022. doi:10.1016/j.amsu.2022.104042

This article originally appeared on Pulmonology Advisor