Low molecular weight heparin in COVID-19 patients prevents delirium and shortens hospitalization
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Low molecular weight heparin in COVID-19 patients prevents delirium and shortens hospitalization Damiano D’Ardes 1 & Claudia Carrarini 2 & Mirella Russo 2 & Fedele Dono 2 & Rino Speranza 2 & Anna Digiovanni 2 & Giovanni Martinotti 2 & Angelo Di Iorio 1 & Marco Onofrj 2 & Francesco Cipollone 1 & Laura Bonanni 2 Received: 9 August 2020 / Accepted: 5 November 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Background COVID-19 patients present with delirium during their hospitalization. Aims To assess the incidence of delirium in hospitalized COVID-19 patients and analyze the possible association with demographic, clinical, laboratory, and pharmacological factors. Methods COVID-19 patients were assessed for clinical signs of delirium and administered the assessment test for delirium and cognitive impairment (4AT) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) scales. Results Out of the 56 patients of our cohort, 14 (25.0%) experienced delirium. The use of low molecular weight heparin (LMWH) (enoxaparin 1 mg/kg/daily) was less frequent in patients with delirium (p = 0.004) and was accompanied by lower C reactive protein (CRP) levels (p = 0.006). Discussion The use of LMWH was associated with absence of delirium, independently of comorbidities and age. Conclusions The use of LMWH may help preventing the occurrence of delirium in COVID-19 patients, with possible reduction of length of stay in the hospital and sequelae. Keywords Delirium . COVID-19 . Low molecular weight heparin . C reactive protein
Introduction Coronavirus disease (COVID-19) represents an enormous new threat to healthcare systems. As the infection has reached the pandemic stage, it has become clear that the older population is most vulnerable to severe respiratory infection with increased mortality [1]. Delirium is a well-recognized complication of respiratory illness in older adults [2]. Delirium in hospitalized patients is a strong independent predictor of mortality, increased hospital length of stay (LOS), cognitive impairment in the long term, increased cost of care, and subsequent hospitalizations [3]. Early studies indicate that 20–30% of COVID-19 patients will present with or develop delirium during their hospitalization, with rates of 60–70% in cases of severe illness [4]. * Laura Bonanni [email protected] 1
Department of Medicine and Aging Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
2
Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
Hospital management of COVID-19 involves precautional isolation and contact with hospital staff mediated by personal protective equipment, which can be depersonalizing and frightening to the elderly, particularly those with underlying cognitive impairment. Thus, the current management approach may exacerbate and prolong the duration of delirium, with consequent poor outcomes and accelerated mortality. In the present study, we assessed the incidence of deliriu
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