Clinical Efficacy of Heparin and Tocilizumab in Patients With Severe COVID-19 Infection

Inclusion criteria

• Age ≥ 18 years;
• Informed consent form signed by the patient or guardian or by audio with the guardian;
• Positive result for COVID-19 in PCR (polymerase chain reaction) in nasopharyngeal swab or tracheal secretion up to 10 days before the inclusion and radiological evidence of COVID-19, by chest radiography or chest computed tomography;
• Need for ≥ 4 L of supplemental oxygen to maintain peripheral oxygen saturation equal to or greater than 93% or need for invasive mechanical ventilation.

Exclusion criteria

• Risk of bleeding:

• Clinical: active bleeding, major surgery in the last 30 days, gastrointestinal bleeding within 30 days;
• Laboratory: platelet count <50,000, INR> 2 or APTT> 50s;
• Known or suspected adverse reaction to UFH, including heparin-induced thrombocytopenia (TIH);
• Adverse reaction or allergy to tocilizumab;
• Use of any of the following treatments: UFH to treat a thrombotic event within 12 hours before inclusion; HPBM in therapeutic dose within 12 hours before inclusion; warfarin (if used 7 days before and if INR greater than 2; thrombolytic therapy within 3 days before; and use of glycoprotein IIb / IIIa inhibitors within the previous 7 days;
• Pregnant or lactating;
• Absolute indication of anticoagulation due to atrial fibrillation or diagnosed thromboembolic event;
• Refusal by family members and / or patient;
• Active tuberculosis;
• Bacterial infection confirmed by culture;
• Neutropenia (<1000 neutrophils / mm3);
• Use of another immunosuppressive therapy that is not a corticosteroid;
• Septic shock.