Challenges in steroids and anicoagulants in severe COVID-19 pneumonia

Abstract

This study is a prospective, experimental study. severe COVID 19 pneumonia admitted at Assiut university hospital from April 10th2020 to September10th, 2020, were included. Then patients were divided into 3 groups. Group A. Included 32 patients treated with dexamethasone and enoxaparin according to D Dimer level, Group B. Included 45 patients treated with prednisolone according to flexible protocol and enoxaparin according to D Dimer, Group C. Included 46 patients treated with prednisolone and therapeutic enoxaparin according to flexible protocol.

Results: 123 severe COVID-19 pneumonia, There was statistically significant difference among 3 groups as regard 3 months cure, lung fibrosis and death(P value 0.028) as there were 12 patients (37.5%)vs26(57.8%)vs31(67.4%) in groups A, B, C respectively experienced cure; while 14patients(43.8%)vs 11(24.4%)vs10 (21.7%) in groups A, B, C respectively had lung fibrosis;6 patients died (18.8%) in group A, and 7 patients died (15.6%) in group B, group C showed lowest mortality ;5(10.9%).In hospital and 3 months outcome for the three groups, there were no significant difference between groups as regards temporary DM and neuromuscular weakness and secondary bacterial infections but there were significant difference between groups as regard pulmonary embolism (6,8,1 patients in group A, B and C respectively) (P-value =0.020) ;bleeding (4,5,1 patients in group A, B and C respectively) (P-value =0.047), hematoma (5,6,3 patients in group A, B and C respectively))(P-value =0.025and myocardial infarctions 3 patients in Group A 3 patient 3 in group B no cases in group C(P-value =0.016).