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Wahid, MD, Lana; Froess, Joshua; Ortel, Thomas L; Zarychanski, Ryan; Gong, Michelle N; Cushman, Mary; Kornblith, Lucy; Castellucci, Lana; Farkouh, Michael E; Gologher, Ewan; McVerry, Bryan J; Bochicchio, Grant V; Duggal, Abhijit; Greenstein, Yonatan; Hanna, Nicholas; Hudock, Kristin; Huang, David T; Hyzy, Robert; Khan, Akram; Krishnan, Vidya; Kutcher, Matthew; Lim, George; Lopez-Sendon Moreno, Jose Luis; Matthay, Michael A; Pandey, Ambarish; Quigley, John; Satterwhite, Lewis; Widmer, Robert J; Jenny Wilson, Jenny; Hochman, Judith S; Berger, Jeffrey S; Neal, Matthew D; Lawler, Patrick R
Circulation (New York, N.Y.), 11/2023, Letnik: 148, Številka: Suppl_1Journal Article
Abstract only Background: SARS-CoV-2 infection potentiates thromboinflammation contributing to poor outcomes in COVID-19. In non-critically ill patients hospitalized for COVID-19, therapeutic-dose heparin improves clinical outcomes. We hypothesized therapeutic-dose heparin impacts thromboinflammatory biomarkers in patients hospitalized for COVID-19 infection. Methods: We conducted a pre-specified secondary analysis of a multi-platform open-label, randomized trial comparing therapeutic-dose versus usual-care thromboprophylaxis-dose heparin in non-critically ill patients hospitalized for COVID-19. Inflammatory markers were analyzed using Wilcoxon rank-sum test and compared based on treatment. Ordinal logistic regression models evaluated for relative D-Dimer change (measured at baseline, day 1, day 3). Odds ratio of a 3-level ordinal outcome (death, survival with organ support, or survival without organ support through 21 days) was determined for relative change. Results: Of 1510 patients, 528 had a D-Dimer on baseline and day 1, and 432 on baseline and day 3. Median age was 60 years (IQR: 50-69) with 41% female and 66% under-represented minorities. Compared to usual-care, therapeutic-dose heparin was associated with a greater drop in D-Dimer at days 1 and 3; other biomarkers were unaffected by treatment (Table 1). D-Dimer at baseline and day 1 had an OR 0.93 (95% CI: 0.88, 0.98) whereas baseline and day 3 had an OR 0.86 (95% CI: 0.78, 0.94) of the ordinal outcome translating in a higher odds of surviving without the need for organ support (adjusted for treatment, gender, and age). Conclusion: In this randomized controlled trial therapeutic-dose heparin was associated with an early reduction in D-Dimer and clinical improvement, suggesting thromboinflammatory mechanisms whereby treatment conferred a clinical benefit. Temporal changes in D-dimer could predict treatment response or may signal need for alternative therapies.
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JCR | SNIP | JCR | SNIP | JCR | SNIP | JCR | SNIP |
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