The role of anti-hypertensive treatment, comorbidities and early introduction of LMWH in the setting of COVID-19: A retrospective, observational study in Northern Italy

Abstract

Background There is a great deal of debate about the role of cardiovascular comorbidities and the chronic use of antihypertensive agents (such as ACE-I and ARBs) on mortality on COVID-19 patients. Of note, ACE2 is responsible for the host cell entry of the virus. Method We extracted data on 575 consecutive patients with laboratory-confirmed SARS-CoV-2 infection admitted to the Emergency Department (ED) of Humanitas Center, between February 21 and April 14, 2020. The aim of the study was to evaluate the role of chronic treatment with ACE-I or ARBs and other clinical predictors on in-hospital mortality in a cohort of COVID-19 patients. Results Multivariate analysis showed that a chronic intake of ACE-I was associated with a trend in reduction of mortality (OR: 0.53; 95% CI: 0.27–1.03; p = 0.06). Increased age (ORs ranging from 3.4 to 25.2 and to 39.5 for 60–70, 70–80 and > 80 years vs < 60) and cardiovascular comorbidities (OR: 1.90; 95% CI: 1.1–3.3; p = 0.02) were confirmed as important risk factors for COVID-19 mortality. Timely treatment with low-molecular-weight heparin (LMWH) in ED was found to be protective (OR: 0.36; 95% CI: 0.21–0.62; p < 0.0001). Conclusions This study can contribute to understand the reasons behind the high mortality rate of patients in Lombardy, a region which accounts for >50% of total Italian deaths. Based on our findings, we support that daily intake of antihypertensive medications in the setting of COVID-19 should not be discontinued and that a timely LMWH administration in ED has shown to decrease in-hospital mortality.

Clinical and electrocardiographic characteristics at admission of COVID-19/SARS-CoV2 pneumonia infection

“…This is the first study describing clinical and ECG characteristics and 30-day outcome in all-comer patients with a history of COVID-19 pneumonia. In this retrospective real-world cohort of COVID-19 patients we confirmed a high short-term mortality, particularly in patients with a more complex CV history and we obtained the following novel key findings: (1) ECG abnormalities at admission are quite common in COVID-19 infection and related to a higher risk of mortality; (2) sinus rhythm at admission has been associated with a lower mortality even after adjustment for confounding factors such as age, sex, diabetes, CAD, ICU and resuscitation; (3) LMWH has been related, as already shown in other studies [ 8 – 11 ], to lower mortality and furtherly improved survival particularly in patients with sinus rhythm at ECG admission; (4) myocardial biomarkers resulted significantly higher in non-survivors compared to survivors, as expression of a more severe disease with multi-organ failure manifestation.…”

COVID-19 and thrombosis: From bench to bedside

“…Because of the high risk of thromboembolic complications and heparin's unique pharmacology demonstrating a reduction in both inflammation and coagulation markers in COVID-19, heparins are being studied for additional clinical endpoints of reduction in hospitalizations, progression to non-invasive mechanical ventilation, as well as mortality. Some, but not all, recently reported retrospective cohort studies, suggest an in-hospital mortality benefit for both UFH and LMWH administered at both prophylaxis and therapeutic treatment doses, especially in patients with more severe COVID-19 as evidenced by elevated D-dimer or need for mechanical ventilation [ 76 , [96] , [97] , [98] , [99] , [100] , [101] , [102] , [103] ] (Summarized in Table 2 ).…”

Impact of Corticosteroids and Anticoagulant Combined Treatment on Patients Affected by COVID-19 Pneumonia

“…Different analyses concerning the role of anticoagulant therapy in patients with COVID-19 disease have been published as well [10,14,[18][19][20][21]49,50]. The rationale of anticoagulant administration, such as the LMWH, in COVID-19 disease is justified by the need to control the hypercoagulable state that has been proved in this patients and could be characterized by a wide clinical manifestation, form a local thrombosis in the pulmonary vasculature to pulmonary embolism, and vascular thromboembolism (VTE), until the onset of severe disseminated intravascular coagulation and thrombotic microangiopathy [4,[51][52][53][54][55].…”

“…Hence, several therapeutic interventions have been proposed to mitigate the inflammatory organ injury in viral COVID-19 disease and, consequently, to reduce the hypercoagulable state [13]. Anticoagulant therapy for the management of patients with pneumonia from SARS-CoV-2 infection is widely discussed [10,[14][15][16][17]; recent retrospective studies seem to show a positive effect on the prognosis [10,14,[18][19][20][21]. Moreover, current trials also showed the improvement of clinical outcomes due to the administration of corticosteroids in critical patients [22][23][24][25][26][27].…”