Is heparin effective in decreasing mortality among hospitalized patients with COVID-19?: Dr Vityala Yethindra

Dr. Vityala Yethindra is the World's youngest scientist in the medicine, a 12-time world record holder, and holding Guinness World record for "longest title of a book." He completed 51 courses in reputed universities, author of 2 books and 23 research articles in reputed journals. He received many national and international awards for his contributions to humanity and medical research.

Unfractionated Heparin (UFH) is used to prevent blood clotting in critically ill patients of coronavirus disease (COVID-19), but not in the case of pregnant women, who may develop venous thromboembolism (VTE).

Why does COVID-19 cause blood clotting?

In patients with COVID-19 after developing symptoms, the lungs are initially affected. The virus enters the body through breathing until it reaches the airways, and in some patients accompanied by an aggressive inflammatory response with the release of a large amount of pro-inflammatory cytokines called “Cytokine Storm.” This phenomenon causes an imbalance in the body and leads to thrombosis and these two mechanisms occur together, such as damage to the endothelium or widespread coagulation within blood vessels. As there is a chance of developing serious conditions UFH is used.

In severe cases, clinical signs of thrombosis develops in the body and patients are at greater risk of having serious conditions that involve obstruction of blood vessels in the heart, brain, and lungs. UFH works by preventing the formation of blood clots, known as thrombi.

Study of Dr. Vityala Yethindra and Tugolbai Tagaev’s team

What was this study objective?

In coagulopathy, COVID-19 is correlated with high mortality due to an increased concentration of D-dimers. This study aimed to elucidate the correlation between the anticoagulant therapy (ACT) with UFH and the mortality rate in hospitalized COVID-19 patients.

What are the methods followed?

The clinical records of 110 patients with COVID-19 admitted to the City Clinical Hospital No. 1 (Bishkek, Kyrgyzstan) until May 18, 2020, were reviewed. Patients with body temperature >37°C and SaO2 <90% at the time of hospitalization and those who were treated with UFH, azithromycin, lopinavir/ritonavir, corticosteroids, and hydroxychloroquine were included in the study.

What do the results describe?

Of the 110 patients, 68 were males and the study population had a mean age of 58.54 years. The median follow-up time was 8 days and all patients treated with UFH had recovered. ACT with UFH was found to be correlated with lower mortality when the analysis was adjusted for age and gender. This correlation was significant for body temperature >37°C and SaO2 <90% as well as for other treatments added. Notably, none of the patients progressed to severe illness.

What does this study conclude?

UFH is simple and safe to use in critical care to prevent or reduce the duration of hospitalization. However, large-scale basic and clinical research is warranted to further understand the specific mechanism of UFH action and to optimize treatment strategies.

Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT)

After vaccination, if individuals develop thrombocytopenia or thrombosis VITT should be suspected. Patients should receive full-dose anticoagulation with heparin but non-heparin is preferred if there is a differential diagnosis of heparin-induced thrombocytopenia.

Recommendations: Walking in the home, avoiding prolonged standing/sitting, avoiding crossing the ledges, changing positions at least every 30-60 minutes, performing flexion-extension exercises and circular movements of the pegs every hour y, avoid dehydration.

Bibliographic reference: Yethindra V, Tagaev T. Decreased mortality among hospitalized coronavirus disease 2019 patients who underwent anticoagulant therapy with heparin. Indian Journal of Pharmacology 2020; 52(4):337-338.

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