Among those with increased D-dimer levels, no reduction seen in primary composite outcome at 28 days, but odds of death decreased
FRIDAY, Nov. 12, 2021 (HealthDay News) — Moderately ill COVID-19 inpatients with increased D-dimer levels receiving therapeutic heparin compared with prophylactic heparin did not have a reduction in the primary outcome of death, mechanical ventilation, or intensive care unit admission at 28 days, but they did have decreased odds of death, according to a study published online Oct. 14 in The BMJ.
Michelle Sholzberg, M.D.C.M., from the University of Toronto, and colleagues conducted a randomized open-label clinical trial involving 465 adults admitted to hospital wards with COVID-19 and increased D-dimer levels between May 29, 2020, and April 12, 2021. Participants were randomly assigned to either therapeutic-dose heparin or prophylactic-dose heparin (228 and 237, respectively).
The researchers found that the primary outcome (composite of death, invasive mechanical ventilation, noninvasive mechanical ventilation, or admission to an intensive care unit assessed up to 28 days) had occurred in 16.2 and 21.9 percent of participants assigned to therapeutic heparin and prophylactic heparin, respectively (odds ratio, 0.69; 95 percent confidence interval, 0.43 to 1.10; P = 0.12). Deaths occurred in 1.8 and 7.6 percent assigned to therapeutic and prophylactic heparin, respectively (odds ratio, 0.22; 95 percent confidence interval, 0.07 to 0.65; P = 0.006). Major bleeding occurred in 0.9 and 1.7 percent of patients assigned to therapeutic and prophylactic heparin, respectively (odds ratio, 0.52; 95 percent confidence interval, 0.09 to 2.85; P = 0.69).
“The mortality rate was significantly lower for the group given a therapeutic dose, and substantial bleeding, the main adverse effect observed in the study, was very low. In other words, the therapy is safe,” a coauthor said in a statement.
Several authors disclosed financial ties to the pharmaceutical industry.
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