Therapeutic doses of heparin may be effective at saving the lives of people with moderate COVID-19 admitted to hospital, according to researchers.
Currently, global guidelines recommend using prophylactic doses of heparin on admission of COVID patients. But a new study has found that therapeutic doses – which are four times greater than the global guidelines suggest – reduced the risk of patients dying by 78%.
The RAPID study involved 465 moderately-ill COVID patients at 28 hospitals in Brazil, Canada, Ireland, Saudi Arabia, United Arab Emirates, and US, admitted between May 2020 and April 2021. Patients had an average age of 60 and oxygen saturation of 93% or less, and raised D-dimer levels. They received heparin doses by injection.
The primary outcome was a composite of death, invasive mechanical ventilation, non-invasive mechanical ventilation, or admission to an intensive care unit, assessed up to 28 days. Although there was no significant reduction in this primary outcome measure, therapeutic doses reduced death from any cause by 78% compared to prophylactic doses. The researchers reported that bleeding side-effects were low in both groups. Results were published in The BMJ.
Researcher Professor Elnara Negri, from São Paulo Hospital das Clinicas in Brazil, said: “We found no significant difference in terms of a need for ICU admission, non-invasive ventilation or intubation, but 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.
“We believe these results should change clinical practice.”
Source:
Sholzberg M, Tang GH, Rahhal H, AlHamzah M, Kreuziger LB, Áinle FN, Alomran F, Alayed K, Alsheef M, AlSumait F, Pompilio CE, Sperlich C, Tangri S, Tang T, Jaksa P, Suryanarayan D, Almarshoodi M, Castellucci LA, James PD, Lillicrap D, Carrier M, Beckett A, Colovos C, Jayakar J, Arsenault MP, Wu C, Doyon K, Andreou ER, Dounaevskaia V, Tseng EK, Lim G, Fralick M, Middeldorp S, Lee AYY, Zuo F, da Costa BR, Thorpe KE, Negri EM, Cushman M, Jüni P; on behalf of RAPID trial investigators. (2021) “Effectiveness of therapeutic heparin versus prophylactic heparin on death, mechanical ventilation, or intensive care unit admission in moderately ill patients with COVID-19 admitted to hospital: RAPID randomized clinical trial.” BMJ, doi: 10.1136/bmj.n2400