Inhaled nebulised unfractionated heparin for the treatment of hospitalised patients with COVID‐19: A multicentre case series of 98 patients

Inhaled nebulised unfractionated heparin for the treatment of hospitalised patients with COVID‐19: A multicentre case series of 98 patients

Aims To determine the safety and efficacy‐potential of inhaled nebulised unfractionated heparin (UFH) in the treatment of hospitalised patients with COVID‐19. Methods Retrospective, uncontrolled multicentre single‐arm case series of hospitalised patients with laboratory‐confirmed COVID‐19, treated w...

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Published in:British journal of clinical pharmacology Vol. 88; no. 6; pp. 2802 - 2813
Main Authors: Haren, Frank M. P., Loon, Lex M., Steins, Anne, Smoot, Thomas L., Sas, Caitlin, Staas, Sabrina, Vilaseca, Alicia B., Barbera, Ruben A., Vidmar, Gustavo, Beccari, Hugo, Popilevsky, Frida, Daribayeva, Eleonora, Venkatesan, Bhuvaneshwari, Mozes, Susan, Postel, Rachel, Popilevski, Natalie, Webb, Andrew, Nunes, Quentin, Laffey, John G., Artigas, Antonio, Smith, Roger, Dixon, Barry, Richardson, Alice, Yoon, Hwan‐Jin, Page, Clive
Format: Journal Article
Language:English
Published: England 01-06-2022
Subjects:
case series
COVID‐19
inhaled heparin
nebulised heparin
pandemic
respiratory failure
SARS‐CoV‐2
unfractionated heparin
COVID-19
SARS-CoV-2
inhaled heparin
case series
respiratory failure
unfractionated heparin
pandemic
nebulised heparin
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Summary:Aims To determine the safety and efficacy‐potential of inhaled nebulised unfractionated heparin (UFH) in the treatment of hospitalised patients with COVID‐19. Methods Retrospective, uncontrolled multicentre single‐arm case series of hospitalised patients with laboratory‐confirmed COVID‐19, treated with inhaled nebulised UFH (5000 IU q8h, 10 000 IU q4h, or 25 000 IU q6h) for 6 ± 3 (mean ± standard deviation) days. Outcomes were activated partial thromboplastin time (APTT) before treatment (baseline) and highest‐level during treatment (peak), and adverse events including bleeding. Exploratory efficacy outcomes were oxygenation, assessed by ratio of oxygen saturation to fraction of inspired oxygen (FiO2) and FiO2, and the World Health Organisation modified ordinal clinical scale. Results There were 98 patients included. In patients on stable prophylactic or therapeutic systemic anticoagulant therapy but not receiving therapeutic UFH infusion, APTT levels increased from baseline of 34 ± 10 seconds to a peak of 38 ± 11 seconds (P < .0001). In 3 patients on therapeutic UFH infusion, APTT levels did not significantly increase from baseline of 72 ± 20 to a peak of 84 ± 28 seconds (P = .17). Two patients had serious adverse events: bleeding gastric ulcer requiring transfusion and thigh haematoma; both were on therapeutic anticoagulation. Minor bleeding occurred in 16 patients, 13 of whom were on therapeutic anticoagulation. The oxygen saturation/FiO2 ratio and the FiO2 worsened before and improved after commencement of inhaled UFH (change in slope, P < .001). Conclusion Inhaled nebulised UFH in hospitalised patients with COVID‐19 was safe. Although statistically significant, inhaled nebulised UFH did not produce a clinically relevant increase in APTT (peak values in the normal range). Urgent randomised evaluation of nebulised UFH in patients with COVID‐19 is warranted and several studies are currently underway.
Bibliography:The authors confirm that the PI for this paper is Professor Frank M.P. van Haren and that he has direct responsibility for the described case‐series.
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ISSN:0306-5251
1365-2125
DOI:10.1111/bcp.15212