PB0075 - Nebulized Heparin in Covid 19 Pneumonia: Efficacy and Safety Versus Heparinoprophylaxis Alone (HEPANEBU)

Background: Factors associated with the development of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and its mortality: advanced age, lymphopenia, organ dysfunction, hypercoagulable state.
Nebulized heparin improved lung function in ventilated patients, equivalent to the use of corticosteroids. It has also been compared with other interventions to stimulate the fibrinolysis or block coagulation to suppress the inflammatory response and reduce lung injury in adult acute respiratory distress syndrome

Aims: Evaluate safety and efficacy of the use of inhalational heparin in patients with pulmonary compromise / pneumonia / SARS associated with COVID-19, from admission to hospitalization. The combination of inhalation heparin with prophylactic doses of LMWH could reduce the progression to severe forms of the disease, and consequently the need for intensive care units and mechanical ventilation

Methods: 178 patients, from 07/01/2020 to 07/01/2021, completed the protocol, 88p (49.4%) in UFH nebulization treatment group, Nebulized Heparin (UNF)5000 IU in Saline Solution1 ml every 8 hours plus Enoxaparin 40mg /d or 60mg/d, 90p (50.6%) in placebo standard care with LMWH. Inclusion criteria: Sars Cov2 disease confirmed by PCR and moderate to severe pneumonia classified by CT.
To nebulized heparin, we have a modified a full-face snorkel mask.

Results: 61.2% men, average age of 59.3 years (SD 14.7).
85% with a clinical score 3/4 at the time of admission. Median time to randomization 24 hours.
Demographic and clinical characteristics were balanced between both groups, with the exception of SaO2 on admission. The SaO2 measured on admission was lower in the group assigned to nebulization with UFH, with a difference that was statistically significant.

Conclusion(s): The combined primary endpoint (PFC), defined as the requirement for ARM, TQT, or mortality, occurred in 21 patients (11.8%). ARM requirement occurred in a lower percentage in the UFH nebulization group [8/88 (9 .1%)] compared to the placebo group [10/90 (11.1%)]