The effect of nebulized heparin in the attenuation of coronavirus disease 2019-induced acute lung injury: a randomized controlled trial

Abstract

Background Since the declaration of coronavirus disease 2019 (COVID-19) as a pandemic by the WHO in January 2020, efforts have been exerted by the scientific community to clarify the pathogenesis of severe acute respiratory syndrome-related coronavirus-induced acute lung injury. Corticosteroids, inhaled vasodilators, B2 agonists, surfactant therapy, antibiotics, and/or antiviral agents are used as a pharmacological treatment for acute respiratory distress syndrome. However, we studied whether prophylactic nebulized heparin could limit this form of lung injury. Patients and methods In all, 100 adult patients with COVID-19 suffering from moderate symptoms of the disease were randomized to prophylactic nebulized heparin (1000 IU/kg) every 6 h or placebo. The primary outcome of this study was the average daily ratio of partial pressure of PaO2 to FiO2 (P/F ratio), while the patient was on room air for 7 days. The secondary outcome was the levels of fibrin degradation products in the pulmonary lavage fluid measured at baseline and on study days 3 and 7 through minibronchoalveolar lavage (mini-BAL) fluid samples. Results We found nebulized heparin was accompanied by a better hypoxic index as it was linked to a lesser D-dimer change at the intermediate phase of the study (day 3). Moreover, nebulized heparin was not associated with bleeding complications. Conclusion In conclusion, prophylactic nebulized heparin may provide an adequate therapeutic approach in COVID-19 patients.