Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy

J Thromb Haemost. 2020 May;18(5):1094-1099. doi: 10.1111/jth.14817. Epub 2020 Apr 27.


Background: A relatively high mortality of severe coronavirus disease 2019 (COVID-19) is worrying, and the application of heparin in COVID-19 has been recommended by some expert consensus because of the risk of disseminated intravascular coagulation and venous thromboembolism. However, its efficacy remains to be validated.

Methods: Coagulation results, medications, and outcomes of consecutive patients being classified as having severe COVID-19 in Tongji hospital were retrospectively analyzed. The 28-day mortality between heparin users and nonusers were compared, as was a different risk of coagulopathy, which was stratified by the sepsis-induced coagulopathy (SIC) score or D-dimer result.

Results: There were 449 patients with severe COVID-19 enrolled into the study, 99 of them received heparin (mainly with low molecular weight heparin) for 7 days or longer. D-dimer, prothrombin time, and age were positively, and platelet count was negatively, correlated with 28-day mortality in multivariate analysis. No difference in 28-day mortality was found between heparin users and nonusers (30.3% vs 29.7%, P = .910). But the 28-day mortality of heparin users was lower than nonusers in patients with SIC score ≥4 (40.0% vs 64.2%, P = .029), or D-dimer >6-fold of upper limit of normal (32.8% vs 52.4%, P = .017).

Conclusions: Anticoagulant therapy mainly with low molecular weight heparin appears to be associated with better prognosis in severe COVID-19 patients meeting SIC criteria or with markedly elevated D-dimer.

Keywords: D-dimer; coagulopathy; coronavirus disease 2019; low molecular weight heparin; sepsis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Anticoagulants / administration & dosage
  • Anticoagulants / therapeutic use*
  • Betacoronavirus*
  • Biomarkers / blood*
  • Blood Coagulation Tests
  • COVID-19
  • Coronavirus Infections* / complications
  • Coronavirus Infections* / drug therapy
  • Coronavirus Infections* / mortality
  • Disseminated Intravascular Coagulation* / drug therapy
  • Disseminated Intravascular Coagulation* / etiology
  • Female
  • Fibrin Fibrinogen Degradation Products
  • Heparin, Low-Molecular-Weight / administration & dosage
  • Heparin, Low-Molecular-Weight / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Pandemics*
  • Platelet Count
  • Pneumonia, Viral* / complications
  • Pneumonia, Viral* / drug therapy
  • Pneumonia, Viral* / mortality
  • Prognosis
  • Prothrombin Time
  • Retrospective Studies
  • SARS-CoV-2
  • Survival Rate


  • Anticoagulants
  • Biomarkers
  • Fibrin Fibrinogen Degradation Products
  • Heparin, Low-Molecular-Weight
  • fibrin fragment D