Use of heparin in patients with severe COVID-19: What is the evidence?

Authors

DOI:

https://doi.org/10.33448/rsd-v10i6.15820

Keywords:

COVID-19; Heparin; SARS-CoV-2; Blood coagulation; Thrombosis; Anticoagulants.

Abstract

The rapid spread of coronavirus disease (COVID-19) worldwide urges the need for studies on the illness and its management. The COVID-19 infection leads to hypercoagulation due to inflammatory cytokine release and D-dimer increase in critically ill patients, resulting in pulmonary thromboembolism (PE) and venous thromboembolism (VTE) evolving to sepsis and death. The study evaluated the currently existing evidence on heparin administration in patients with severe COVID-19. An integrative literature review was done by searching for scientific studies in the PubMed, Scopus, Embase, and Web of Science databases. The analyzed studies showed that heparin use in critically ill patients could efficiently prevent thrombotic events and reduce the exacerbated inflammatory process. However, further investigation on the effect on patients is still needed. The use of heparin in critically ill COVID-19 patients has been prescribed increasingly by doctors. But its use has not yet had its outcomes well established in the literature. Therefore, deeper investigations and new research development are needed to clarify potential beneficial effects.

References

Barnes, G. D., Burnett, A., Allen, A., Blumenstein, M., Clark, N. P., Cuker, A., Dager, W. E., Deitelzweig, S. B., Ellsworth, S., Garcia, D., Kaatz, S., & Minichiello, T. (2020). Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum. Journal of thrombosis and thrombolysis, 50(1), 72–81. https://doi.org/10.1007/s11239-020-02138-z.

Bocchese, N. V., Dávila, N. G., Rodrigues, M. B. M., Araújo-Neto, I., Costa, M. O., et al. (2020). COVID-19 and Liver Injury: Hepatology Perspectives. J Clin Gastroenterol Treat. 74(6). 10.23937/2469-584X/1510074.

Boccia, M., Aronne, L., Celia, B., Mazzeo, G., Ceparano, M., D'Agnano, V., Parrella, R., Valente, T., Bianco, A., & Perrotta, F. (2020). COVID-19 and coagulative axis: review of emerging aspects in a novel disease. Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace, 90(2), 10.4081/monaldi.2020.

Dantas, T. C. de A., Gomes, A. C. A., Lima, I. P. C., Lucas, B. B., Aguiar, M. R. de., Cavalcanti, T. C. de H., Pinheiro, F. I., Rêgo, A. C. M., & Araújo-Filho, I. (2021). Corticosteroid therapy in patients with severe COVID-19. Research, Society and Development, 10(1), e58910112114. https://doi.org/10.33448/rsd-v10i1.12114.

D’Souza, R., Malhamé, I., Teshler, L., Acharya, G., Hunt, B. J., & McLintock, C. (2020). A critical review of the pathophysiology of thrombotic complications and clinical practice recommendations for thromboprophylaxis in pregnant patients with COVID-19. Acta Obstet Gynecol Scand. 99. 1110– 1120. https://doi.org/10.1111/aogs.13962.

Goés, A. B. M., Cardoso, B. B., Tavares, F. A. F., do Monte, R. R. L., Melo, R. C., et al. (2020). COVID-19 and Nervous System: Under Estimated Clinical and Prognostic Aspects. Int J Neurol Neurother. 100(7). doi.org/10.23937/2378-3001/1410100.

Gómez-Mesa, J. E., Galindo-Coral, S., Montes, M. C., & Muñoz Martin, A. J. (2021). Thrombosis and Coagulopathy in COVID-19. Current problems in cardiology, 46(3), 100742. https://doi.org/10.1016/j.cpcardiol.2020.100742.

Guevara-Noriega, K. A., Lucar-Lopez, G. A., Nuñez, G., Rivera-Aguasvivas, L., & Chauhan, I. (2020). Coagulation Panel in Patients with SARS-CoV2 Infection (COVID-19). Annals of clinical and laboratory science, 50(3), 295–298.

Helms, J., Severac, F., Merdji, H., Schenck, M., Clere-Jehl, R., Baldacini, M., Ohana, M., Grunebaum, L., Castelain, V., Anglés-Cano, E., Sattler, L., & Meziani, F. (2021). Higher anticoagulation targets and risk of thrombotic events in severe COVID-19 patients: bi-center cohort study. Ann Intensive Care. 11(1). https://doi.org/10.1186/s13613-021-00809-5.

Iba, T., Warkentin, T. E., Thachil, J., Levi, M., & Levy, J. H. (2021). Proposal of the Definition for COVID-19-Associated Coagulopathy. Journal Of Clinical Medicine. 10(2), 191. https://doi.org/10.3390/jcm10020191.

Lindahl, U., & Li, J. P. (2020). Heparin - An old drug with multiple potential targets in Covid-19 therapy. Journal of thrombosis and haemostasis: JTH, 18(9), 2422–2424. https://doi.org/10.1111/jth.14898.

Maldonado, E., Tao, D., & Mackey, K. (2020). Antithrombotic Therapies in COVID-19 Disease: a Systematic Review. J GEN INTERN MED 35, 2698–2706. https://doi.org/10.1007/s11606-020-05906-y.

Marietta, M., Coluccio, V., & Luppi, M. (2020). COVID-19, coagulopathy and venous thromboembolism: more questions than answers. Internal and emergency medicine, 15(8), 1375–1387. https://doi.org/10.1007/s11739-020-02432-x.

Marinho, V. R. D., Abreu, C. A., Pereira, L. H. M., & Lemos, T. E. V. (2021). Aplicação de zinco em pacientes com COVID-19: o que há de evidência?. Science & Saúde: Atualizações sobre o COVID-19, 1(18), 170-179. https://doi.org/10.47402/ed.ep.c20212518201.

Menezes-Rodrigues, F. S., Tavares, J. G. P., Oliveira, M. P., Carvalho, R. G., Errante, P. R., Taha, M. O., Fagundes, D. J., & Caricati-Neto, A. (2020). Anticoagulant and antiarrhythmic effects of heparin in the treatment of COVID-19 patients. Journal of thrombosis and haemostasis: JTH, 18(8), 2073–2075. https://doi.org/10.1111/jth.14902.

Miesbach, W., & Makris, M. (2020). COVID-19: Coagulopathy, Risk of Thrombosis, and the Rationale for Anticoagulation. Clinical and applied thrombosis/hemostasis: official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis, 26. https://doi.org/10.1177/1076029620938149.

Pereira, A. S., Shitsuka, D. M., Parreira, F. J., & Shitsuka, R. (2018). Metodologia Da Pesquisa Científica (1st ed.). Santa Maria: Universidade Federal de Santa Maria.

Ranucci, M., Sitzia, C., Baryshnikova, E., Di Dedda, U., Cardani, R., Martelli, F., & Romanelli, M. C. (2020). Covid-19-Associated Coagulopathy: Biomarkers of Thrombin Generation and Fibrinolysis Leading the Outcome. Journal of Clinical Medicine, 9(11), 3487. https://doi.org/10.3390/jcm9113487.

Riveira-Caravaca, J. M., Nðñez-Gil, I. J., Vivas, D., Viana‐Llamas, M. C., Uribarri, A., Becerra-Muñoz, V. M., Trabattoni, D., Rozas, I. F., Feltes, G., & López-Pais, J. (2020). Clinical profile and prognosis in patients on oral anticoagulation before admission for COVID‐19. European Journal Of Clinical Investigation, [S.L.], 51(1), 1-11. https://doi.org/10.1111/eci.13436.

Riveros, D., Maymó, D., Laviano, J., Fornillo, F. F., Fernández, J., Benzadon, R., Solimano, J., Cacchione, R., Riera, L., Duarte, P., Cazap, N., Gotta, D., García Altuve, J., Valentini, R., & Dupont, J. (2020). Coagulopatía y COVID-19. Recomendaciones para una realidad cambiante [Coagulopathy and COVID-19. Recommendations for a changing reality]. Medicina, 80(5), 505–511.

Seffer, M-T., Cottam, D., Fornic, L. G., & Kielsteina, J. T. (2020). Heparin 2.0: A New Approach to the Infection Crisis. Karger Journals, 50(1), 28-34. https://doi.org/10.1159/000508647.

Schmoch, T., Brenner, T., Becker-Pennrich, A., Hinske, L. C., Weigand, M. A., Briegel, J., Möhnle, P., & SepNet Study Group (2021). Therapie der sepsisinduzierten Koagulopathie: Ergebnisse einer deutschlandweiten Umfrage auf Intensivstationen [Treatment of sepsis-induced coagulopathy: Results of a Germany-wide survey in intensive care units]. Der Anaesthesist, 1–9. Advance online publication. https://doi.org/10.1007/s00101-021-00916-9.

Schulman, S. (2020). Coronavirus Disease 2019, Prothrombotic Factors, and Venous Thromboembolism. Semin Thromb Hemost. 46(7). 772-776. https://doi.org/10.1055/s-0040-1710337.

Stratton, C. W., Tang, Y., & Lu, H. (2020). Pathogenesis‐directed therapy of 2019 novel coronavirus disease. Journal Of Medical Virology. 93(3), 1320-1342. https://doi.org/10.1002/jmv.26610.

Tang, N., Bai, H., Chen, X., Gong, J., Li, D., & Sun, Z. (2020). Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. Journal of thrombosis and haemostasis: JTH, 18(5), 1094–1099. https://doi.org/10.1111/jth.14817.

Downloads

Published

30/05/2021

How to Cite

MARINHO, V. R. D. .; VILLARIM, C. V. O. .; SILVA, L. C. C. e .; SILVA, A. L. C. e .; ARAÚJO-NETO, I. .; CALDAS, D. M. D. R. .; RÊGO, A. C. M. .; ARAÚJO-FILHO, I. . Use of heparin in patients with severe COVID-19: What is the evidence?. Research, Society and Development, [S. l.], v. 10, n. 6, p. e28910615820, 2021. DOI: 10.33448/rsd-v10i6.15820. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/15820. Acesso em: 15 jun. 2021.

Issue

Section

Review Article