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expert reaction to study looking at inhaled heparin as a possible treatment for COVID-19

A study published in British Journal of Clinical Pharmacology looks at the use of inhaled heparin for the treatment of hospitalised patients with COVID-19.


Prof Stephen Evans, Professor of Pharmacoepidemiology, London School of Hygiene & Tropical Medicine, said:

“Inhaled heparin has been used in the past in patients with damaged lungs, though it is not an authorised use of the drug.

“This is a “case series” which describes a set of patients in hospital with Covid and treated with inhaled heparin, but no comparison group.

“Some of the patients were already being ventilated mechanically and over 70% of them died in spite of the treatments they were given.

“Many patients were on other drugs or treatments, some of which are known to be beneficial (e.g. corticosteroids) and others not (e.g. hydroxychloroquine).

“While there were signs of some limited improvements seen, the study is far from justifying routine use of inhaled heparin. It may justify its use in a properly controlled randomised trial. The expected occurrence of bleeding with any anti-coagulant occurred in a number of patients and so, even if it is subsequently shown to be beneficial, the balance of harm and benefit both overall and for individual patients will need to be assessed carefully.”


Prof Penny Ward, Independent Pharmaceutical Physician, and Visiting Professor in Pharmaceutical Medicine at King’s College London, said:

“Inhaled unfractionated heparin has been investigated over several years as a potential treatment for multiple lung disorders including viral pneumonia, cystic fibrosis and lung injury. This report describes the safety of low, medium and high dose nebulised inhaled unfractionated heparin used for the treatment of covid pneumonia based on retrospective data collection from patients treated with various doses. The information provided demonstrate that inhaled heparin is well tolerated with minimal risk of major bleeding events. Rapid improvement in oxygenation is noted post therapy in both intubated and non intubated patients, although as this is a case series description without a control untreated population it is uncertain whether or not the use of this treatment improves outcomes over and above standard of care. The data provided support the conduct of randomised controlled studies of this intervention to answer this question once and for all; as these have already started it is hoped that the information will be available soon.”



Inhaled nebulised unfractionated heparin for the treatment of hospitalised patients with COVID-19: A multicentre case series of 98 patients’ by Frank M. P. van Haren et al. was published in the in British Journal of Clinical Pharmacology on Wednesday 19th January.



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Declared interests

Prof Stephen Evans: “No conflicts of interest.  I am funded (one day per week) by LSHTM.  They get funding from various companies, including Astra Zeneca and GSK but I am not funded by them, I have no involvement in obtaining funding from them and I am not an investigator on any grants obtained from them.  I am the statistician to the ‘meta-Data Safety and Monitoring Board’ for CEPI.  I am paid for my attendance at those meetings and will be paid expenses for travel if that occurs.  I am a participant in the Oxford/Astra Zeneca trial, and on 13th January 2021 learnt I had received the active vaccine.”

Prof Penny Ward: “I am semi-retired, but I am owner/Director of PWG Consulting (Biopharma) Ltd a consulting firm advising companies on drug and device development. Between December 2016 and July 2019 I served as Chief Medical Officer of Virion Biotherapeutics Ltd, a company developing antiviral treatments for respiratory viral diseases. Previous employee of Roche, makers of tocilizumab (anti IL6 antibody) and CMO of Novimmune, makers of empalumab (anti IFN gamma antibody).”


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