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?:abstract
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Objectives To evaluate the impact of low molecular weight heparin (LMWH) on the outcome of patients with SARS-CoV-2 pneumonia Methods Prospective observational study including consecutive patients with laboratory confirmed SARS-CoV-2 pneumonia admitted to the University Hospital of Pisa (4th March-30th April 2020) Demographic, clinical, and outcome data were collected The primary endpoint was 30-day mortality The secondary endpoint was a composite of death or severe ARDS LMWH, hydroxychloroquine, doxycycline, macrolides, antiretrovirals, remdesivir, baricitinib, tocilizumab, and steroids were evaluated as treatment exposures of interest First, a Cox-regression analysis, in which treatments were introduced as time-dependent variables, was performed to evaluate the association of exposures and outcomes Then, a time-dependent Propensity-score (PS) was calculated and a PS-matching performed for each treatment variable Results Among 315 patients with SARS-CoV-2 pneumonia, 70 (22 2%) died during hospital stay The composite endpoint was achieved by 114 (36 2%) patients Overall, 244 (77 5%) patients received LMWH, 238 (75 5%) hydroxychloroquine, 201 (63 8%) proteases inhibitors, 150 (47 6%) doxycycline, 141 (44 8%) steroids, 42 (13 3%) macrolides, 40 (12 7%) baricitinib, 13 (4 1%) tocilizumab, and 13 (4 1%) remdesivir At multivariate analysis, LMWH was associated with a reduced risk of 30-day mortality (HR 0 36 [95% CI 0 21-0 6], p<0 001) and composite endpoint (HR 0 61 [95% CI 0 39-0 95], p=0 029) The PS-matched cohort of 55 couples confirmed the same results for both primary and secondary endpoint Conclusions This study suggests that LMWH might reduce the risk of in-hospital mortality and severe ARDS in Covid-19 Randomized controlled trials are warranted to confirm these preliminary findings
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