Low Molecular Weight Heparin Reduces Arterial Blood Lactic Acid Content and Increases Estimated Glomerular Filtration Rate in Patients with Moderate Covid-19 Pneumonia
Coronavirus disease 2019 (Covid-19) remains a serious global health threat, characterized by respiratory function deterioration and potential multiple organ injury. The disease, caused by the Severe Acute Respiratory Syndrome-related coronavirus 2 (SARS-CoV-2), has led to millions of confirmed cases and deaths worldwide. Among the complications associated with Covid-19, coagulation dysfunction has emerged as a significant contributor to mortality, with studies indicating that a majority of patients who die from the disease meet the diagnostic criteria for disseminated intravascular coagulation (DIC). This has prompted investigations into the potential benefits of low molecular weight heparin (LMWH) in treating Covid-19, particularly in improving organ function and reducing mortality.
The study in focus aimed to evaluate the effects of LMWH on organ function recovery in patients with moderate Covid-19 pneumonia. Conducted at the Shanghai Public Health Clinical Center, the research involved a retrospective analysis of patients admitted between January 18 and April 18, 2020. Patients were selected based on specific inclusion criteria, including increased D-dimer levels, a body mass index (BMI) greater than 30 kg/m², or a history of diabetes. The LMWH group consisted of 41 patients who received the LMWH protocol, while the control group included 82 patients who did not receive LMWH, matched by propensity score.
The LMWH protocol involved a daily subcutaneous injection of 4100 units of LMWH from admission until D-dimer levels normalized or for 5 to 7 days. The study collected and compared general clinical information, renal function indicators, arterial blood gas analyses, arterial blood lactic acid content, and coagulation indexes at various time points (0, 3, 7, and 11 days after admission).
The findings revealed significant improvements in the LMWH group compared to the control group. Specifically, the arterial blood lactic acid content was lower in the LMWH group at day 11 (1.3 mmol/L vs. 1.2 mmol/L, P = 0.016). The estimated glomerular filtration rate (eGFR) was higher in the LMWH group at day 7 (108.54 mL/min vs. 116.85 mL/min, P = 0.039) and day 11 (113.74 mL/min vs. 128.31 mL/min, P = 0.003). Additionally, serum creatinine levels (Scr) were lower in the LMWH group at day 7 (62.13 mmol/L vs. 55.49 mmol/L, P = 0.038) and day 11 (63.35 mmol/L vs. 51.62 mmol/L, P = 0.005).
The study also explored the effects of LMWH on lung function and coagulation parameters. While there was a trend towards reduced PaCO2 and improved coagulation indexes in the LMWH group, these differences were not statistically significant. However, the reduction in arterial blood lactic acid levels and the improvement in eGFR suggest that LMWH may mitigate microthrombosis and enhance renal function in moderate Covid-19 pneumonia patients.
The discussion section of the study contextualizes these findings within the broader understanding of Covid-19 pathophysiology. The virus primarily targets vascular endothelial cells, leading to endothelial dysfunction and hypercoagulability. This can result in complications such as DIC, which is a frequent cause of death in Covid-19 patients. The potential of LMWH to prevent viral adhesion and its anti-inflammatory effects have been highlighted in previous research. The study’s results align with these observations, indicating that LMWH may protect kidney function by reducing glomerular microthrombosis and improving microcirculation.
The study also addresses the issue of acute kidney injury (AKI) in Covid-19 patients, which is a negative prognostic factor for survival. The pathophysiologic mechanisms leading to AKI in Covid-19 include organ interactions, endothelial dysfunction, hypercoagulability, rhabdomyolysis, and sepsis. The improvement in eGFR observed in the LMWH group supports the hypothesis that LMWH can protect kidney function by reducing microthrombosis and enhancing blood flow.
In conclusion, the study provides preliminary evidence that LMWH anticoagulant therapy in the early stages of moderate Covid-19 pneumonia can improve eGFR and reduce arterial blood lactic acid levels. These findings suggest that LMWH may have a protective effect on organ function in Covid-19 patients, particularly in mitigating microthrombosis and improving renal function. However, the authors emphasize the need for randomized controlled trials to further investigate these findings and establish the therapeutic potential of LMWH in Covid-19 treatment.
doi.org/10.1097/CM9.0000000000001923
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