The use of Heparin in Covid patients. The results of the Start-Covid Registry 19

Italfarmaco and the Arianna Anticoagolazione Foundation announce the results of the Start-Covid-19 study, an all-Italian project born from an idea of ​​the Foundation, founded and chaired by Gualtiero Palareti, professor in Cardiovascular Diseases at the University of Bologna. Start-Covid-19 is among the initiatives supported by Italfarmaco as part of the GhemaVid Platform, conceived by the Italian pharmaceutical company to select, develop and support clinical, pre-clinical and educational medical-scientific projects, which increase and disseminate knowledge on Covid-19 and on the role of Enoxaparin in the management and prevention of the fearful thromboembolic complications of this disease.

Start-Covid-19 provided important results thanks to the analysis of the medical records of 1,135 patients hospitalized between 1 March and 30 June 2020 in the ordinary hospital wards of the thirty Italian centers that participated in the study.

Among the main objectives of the study, that of documenting the effect of anticoagulant-antithrombotic drugs, such as heparins, on the clinical evolution of Covid-19. For this purpose, all available information was collected from the clinical characteristics of the patients, including laboratory data, intercurrent arterial and venous thrombotic events, the type and dosage of treatments performed during hospitalization, the clinical evolution of patients with Covid-19 and the trend of coagulation parameters.

“Patients included in the study had a median age of 71 years”, specifies Daniela Poli of SOD Atherothrombotic Diseases, University Hospital-Careggi, Florence, coordinating center of the study, and vice-president of the Federation of Centers for the Diagnosis of Thrombosis and for the Surveillance of Anticoagulant Therapies. “Many patients had associated diseases, in particular: 52.2% arterial hypertension, 10.2% coronary artery disease, 17.4% diabetes mellitus, 23.3% reduction in renal function and 7.6% atrial fibrillation, but 37, 2% of patients did not present, at the time of admission, any relevant pathology other than Covid-19. During hospitalization 769 patients (70.7%) received anticoagulant-antithrombotic treatment. This treatment was mainly carried out at a prophylactic dosage (78.9%), while patients treated with therapeutic or sub-therapeutic doses were equal to 19.1%. The most widely used anticoagulant-antithrombotic drug was enoxaparin (92.3%). The patients who received the anticoagulant-antithrombotic treatment were “more severe”, ie they had a significantly higher number of comorbidities than those who did not receive such treatment. However, mortality was significantly lower in patients who received the treatment (and who were also “more severe”) than in those who did not (16.5% vs 22.7%, p = 0.02) . By dividing the population by age groups (quartiles), we documented that among the older patients (≥59 years, corresponding to the upper 3 quartiles) this difference was even greater (20.2% vs 31.7%, p = 0.001). Multivariate analysis based on age confirmed that heparin treatment was associated with a significant reduction in mortality, with an odds ratio of 0.4 (95% CI 0.3-0.6), corresponding to a 60% reduction in the risk of mortality associated with the use of heparin compared to subjects who did not receive heparin ”.

This represents a data of great interest as anticoagulant treatment, in particular with Enoxaparin, has been associated with the reduction of mortality in a large group of patients hospitalized for Covid-19 in ordinary hospitalization (patients in intensive care were excluded).

Start-Covid-19 is a retrospective, observational, national and multicenter registry that collected data on clinical characteristics, laboratory results and drugs used in patients hospitalized for Sars-CoV-2 virus infection. The study was carried out independently by the Arianna Anticoagulation Foundation.

“We are very pleased with the data we have obtained from the Start-Covid-19 on an outcome as important as mortality in a population of high-risk patients, also considering the associated comorbidities”, says Professor Gualtiero Palareti. “This represents a further important step in the management of coagulation complications in patients affected by Covid-19 and allows us to look to the future in a more optimistic way”.

“The data obtained from this study highlights another interesting aspect”adds Dr. Poli. “Enoxaparin was found to be a very effective and safe drug in our and many other studies, especially when used in a prophylactic dosage. Our results confirm the great handling of this drug, which has been known to specialist doctors and general practitioners for many years. Enoxaparin can be considered an advantageous therapeutic tool even in the out-of-hospital context and an effective weapon to control the thromboembolic risk in Covid-19 patients treated at home. This would help reduce hospitalizations with better patient management right at home. “

Italfarmaco, a leading Italian company in the study and development of drugs for the control of cardiovascular risk and thrombosis, has always been engaged in the production and distribution of standard heparins and low molecular weight heparins, key drugs in the prevention and treatment of problems. coagulation and thrombosis control.

“We are very proud of the results obtained by the Start-Covid-19 study”, says Paolo Zambonardi, CEO of Italfarmaco, “Because thanks to these“ real word ”data it will be possible to further improve the extremely complex management of Covid-19 patients in the different phases of the disease. An important result also for Italfarmaco which, with the GhemaVid platform, has made an effective and flexible tool available to the scientific community to deepen knowledge on Covid-19 and help combat the dreaded thromboembolic complications of this disease. We are very proud to be alongside clinicians in this battle ”.