Role of Nebulised Heparin as an Adjunct in Critically-ill COVID-19 Patients: A Randomised Controlled Trial
Introduction: Coronavirus Disease 2019 (COVID-19) is associated with an increased risk of Venous Thromboembolism (VTE) and coagulopathy. The available studies have shown the anticoagulant and mucolytic effects of nebulised heparin in non COVID-19 patients. Hence it was decided to conducted to s...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2023-12-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://www.jcdr.net/articles/PDF/18808/66578_CE[Ra1]_F(IS)_QC(SD_RDW_IS)_PF1(RI_OM)_PFA(OM)_PN(KM).pdf |
| Summary: | Introduction: Coronavirus Disease 2019 (COVID-19) is
associated with an increased risk of Venous Thromboembolism
(VTE) and coagulopathy. The available studies have shown the
anticoagulant and mucolytic effects of nebulised heparin in
non COVID-19 patients. Hence it was decided to conducted
to study the efficacy of nebulised heparin in patients suffering
from COVID-19 pneumonia requiring mechanical ventilation.
Aim: To evaluate the safety and efficacy of nebulised heparin
administered to patients with COVID-19.
Materials and Methods: A double-blinded randomised
controlled trial was conducted at Basaveshwara Medical
College and Hospital in Chitradurga, Karnataka, India among
100 patients with COVID-19 who required mechanical ventilation
from February 2021 to May 2021. They were randomly assigned
to two equal groups of 50 patients each. One group received
nebulised heparin, and the other group received a placebo.
The patients were compared for baseline characteristics,
coagulation characteristics, and Oxygen Saturation (SpO2
). Data
were analysed using Statistical Package for Social Sciences
(SPSS) version 22.0, expressed as frequency and percentages,
and displayed in tables and figures. The association between
two variables was determined using the Chi-square test and
paired t-test.
Results: The two groups did not differ significantly in terms
of age, sex, respiratory failure, vasopressin use, and severity
score. Respiratory failure was present in 54% of the heparin
group and 38% of the placebo group. Vasopressin was used in
64% of the heparin group and 56% of the placebo group. The
severity score was 4.44 in the heparin group and 4.42 in the
placebo group. Activated Partial Thromboplastin Time (APTT)
levels did not differ significantly between the groups. None of
these parameters showed significant differences between the
heparin and placebo groups. However, both groups showed a
significant difference in Thrombin Antithrombin (TAT) complex
levels from baseline to follow-up (p<0.05). D-Dimer levels
decreased during follow-up, and Spo2 improved significantly in
the nebulised heparin group compared to the placebo group.
Conclusion: Nebulised heparin used as an adjunct in critically
ill COVID-19 patients was shown to decrease TAT and
D-Dimer levels. Nebulised heparin also significantly improved
oxygenation levels. Importantly, heparin nebulisation was not
associated with any adverse events, even when administered
with systemic heparin. |
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| ISSN: | 2249-782X 0973-709X |