- LMWH (low molecular weight heparin) at a prophylactic dose may reduce mortality in patient with markedly elevated D-dimers (6 upper limit normal) or a SIC (sepsis-induced-coagulopathy criteria) ≥4, as 28-day mortality rates were statistically lower for patients meeting these criterias.
- Higher doses should be considered in patient with a high body mass index.
- Rationale of heparin therapy:
- Counter the hypercoagulable state induced by infection;
- Prevent the formation of microthrombosis formation in pulmonary small vessels and therefore prevent anoxia;
- Possesses anti-inflammatory properties;
- Early experimental studies show a possible antiviral role of heparin.
- Hyperfibrinolytic consumptive DIC (disseminated intravascular coagulopathy) with bleeding diathesis has not yet been reported.
|Platelet Count (x109/L)||1||100-150|
|Total score for SIC||≥4|
This table was reproduced from the ISTH SIC Scoring system.
This data comes from a retrospective analysis of 99 patients with severe disease receiving 7 days or longer of heparin (mainly low molecular weight heparin) and 350 patients with severe disease without heparin therapy in Tongji Hospital, Wuhan, China. The prophylactic dose of LMWH was mostly used. The 28-day mortality between heparin users and nonusers were compared and stratified by the sepsis-induced coagulopathy (SIC) score (International Society on Thrombosis and Haemostasis criteria) and D-dimer result. SIC criteria includes platelet count, PT-INR and SOFA score.
- Tang N., Bai H., Chen X., Gong J., Li D., Sun Z. (March 27, 2020). Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. Journal of Thrombosis and Haemostasis (JTH). https://doi.org/10.1111/jth.14817
- Yin S., Huang M., Li D., Tang N. (April 03, 2020) Difference of coagulation features between severe pneumonia induced by SARS-CoV2 and non-SARS-COV2. DOI: 10.1007/s11239-020-02105-8
- Thachil J. (April 2, 2020). The Versatile Heparin in COVID-19. Journal of Thrombosis and Haemostasis (JTH). https://doi.org/10.1111/jth.14821
- Connors J. (April 17, 2020). Thromboinflammation and the hypercoagulability of COVID-19. Journal of Thrombosis and Haemostasis (JTH). https://doi.org/10.1111/jth.14849