Treating COVID-19-Associated Coagulopathy: Unfractionated Heparin vs LMWH

Anticoagulant efficacy to prevent VTE after hip and knee arthroplasty
Anticoagulant efficacy to prevent VTE after hip and knee arthroplasty
Which is more effective in treating coagulopathy in critically ill patients with COVID-19, unfractionated heparin or low-molecular-weight heparin?

Among hospitalized patients with confirmed COVID-19, those who receive unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) demonstrate a significant decrease in D-dimer values, which suggests that both agents are similarly effective in the treatment of coagulopathy. These were among study findings published in Annals of Medicine and Surgery (London).

Patients who are critically ill with COVID-19 have a high reported incidence of thrombotic complications, which often result in poor clinical outcomes, noted investigators for the current study. Several studies have reported that coagulopathic complications are common among individuals with severe COVID-19, with the disease known to predispose patients to both venous and arterial thromboembolic disease. Indications of disease severity and establishment of coagulopathy vary, including elevated D-dimer levels, thrombocytopenia, and prolonged prothrombin time and activated partial thromboplastin clotting time (aPTT).

Investigators conducted a retrospective cohort study at the Islamic Hospital Jakarta Sukapura in North Jakarta, Indonesia, to compare the effectiveness of UFH with LMWH (fondaparinux) in patients hospitalized with COVID-19 infection who exhibited hypercoagulable complications. Data from pretests and post-tests were obtained from patients’ electronic health records.

A total of 98 patients were evaluated, 35 of whom were treated with UFH and 63 of whom were treated with LMWH. Overall, 52% of participants were women; 30.6% of patients were older than 60 years of age. The investigators compared patient D-dimer values following UFH administration and following LMWH administration.

No significant differences were found in level of increase or decrease in D-dimer values between the UFH and LMWH groups (P =.193 and P >.05, respectively), thus demonstrating no significant association between aPTT values and patient status.

The greatest reductions in D-The greatest reductions in D-dimer value (0.01±0.5 g fibrinogen equivalent unit /mL) were reported among 34.3% of participants in the UFH group vs 23.8% of those in the LMWH group.

A key limitation is incomplete data, given that not all inpatients with confirmed COVID-19 infection undergo a thorough coagulation examination prior to and following administration of UFH and LMWH.

The investigators concluded that “There was a tendency toward increased D-dimer, normal prothrombin time, normal activated partial thromboplastin clotting time, and increased fibrinogen values in each COVID-19 patient. The results demonstrated a significant relationship between the D-dimer and prothrombin time parameter in confirmed COVID-19 inpatients.”


Fachri M, Hatta M, Tarigan SNNA, et al. Heparin for patients with coronavirus disease 2019 and hypercoagulation complications: a cohort study. Ann Med Surg (Lond). Published online June 28, 2022. doi:10.1016/j.amsu.2022.104042