Early prophylactic anticoagulation with heparin alleviates mortality in critically ill patients with sepsis:a retrospective analysis from the MIMIC-IV database

Background:Minimal data exist on anticoagulation use and timing and the dose of heparin in patients with sepsis,and whether heparin use improves sepsis survival remains largely unclear.This study was performed to assess whether heparin administration would provide a survival advantage in critically ill patients with sepsis.Methods:A retrospective cohort study of patients with sepsis in the Medical Information Mart for Intensive Care(MIMIC)-IV database was conducted.Cox proportional hazards model and propensity score matching(PSM)were used to evaluate the outcomes of prophylactic anticoagulation with heparin administered by subcutaneous injection within 48 h of intensive care unit(ICU)admission.The primary outcome was in-hospital mortality.Secondary outcomes included 60-day mortality,length of ICU stay,length of hospital stay and incidence of acute kidney injury(AKI)on day 7.EValue analysis were used for unmeasured confounding.Results:A total of 6646 adult septic patients were included and divided into an early prophylactic heparin group(n=3211)and a nonheparin group(n=3435).In-hospital mortality in the heparin therapy group was significantly lower than that in the nonheparin group(prematched 14.7 vs 20.0%,hazard ratio(HR)0.77,95%confidence interval(CI)[0.68-0.87],p<0.001,and postmatched 14.9 vs 18.3%,HR 0.78,95%CI[0.68-0.89],p<0.001).Secondary endpoints,including 60-day mortality and length of ICU stay,differed between the heparin and nonheparin groups(p<0.01).Early prophylactic heparin administration was associated with in-hospital mortality among septic patients in different adjusted covariates(HR 0.71-0.78,p<0.001),and only administration of five doses of heparin was associated with decreased in-hospital mortality after PSM(HR 0.70,95%CI 0.56-0.87,p<0.001).Subgroup analysis showed that heparin use was significantly associated with reduced in-hospital mortality in patients with sepsis-induced coagulopathy,septic shock,sequential organ failure assessment score≥10,AKI,mechanical ventilation,gram-positive bacterial infection and gram-negative bacterial infection,with HRs of 0.74,0.70,0.58,0.74,0.73,0.64 and 0.72,respectively(p<0.001).E-Value analysis suggested robustness to unmeasured confounding.Conclusions:This study found an association between early administration prophylactic heparin provided to patients with sepsis and reduced risk-adjusted mortality.A prospective randomizedcontrolled study should be designed to further assess the relevant findings.

Venous thromboembolism in patients with COVID-19.A prevalent and a preventable complication of the pandemic

Coronavirus disease 2019 or most commonly known as COVID-19 is a trending global infectious disease which a few months ago was affirmed as a global health emergency or a pandemic by the WHO Emergency Committee.The common symptoms manifested in this pandemic disease are high grade fever,cough,fatigue,shortness of breath and flu like symptom which can evolve into severe respiratory disorders such as pneumonia,acute respiratory distress syndrome(ARDS)and/or end-organ failure.Factors that contribute to the severity or high mortality rate in COVID-19 include old age,comorbidities like hypertension,diabetes,hyperlipidaemia,neutrophilia,and organ and coagulation dysfunction.Disseminated intravascular coagulation and other various coagulopathies including Venous thromboembolism have known to become a major contributing factor to high mortality rate.Venous thromboembolism is a disease which is a combination of deep vein thrombosis and pulmonary embolism.Prophylactic anticoagulation in patients prone to or with a pre-existing history of venous thromboembolism is associated with decreased mortality in severe COVID-19 pneumonia.This review article focuses upon COVID-19 and increased incidence of venous thromboembolism in patients infected by COVID-19 along with the role it has in high mortality rate in COVID-19 patients.