Inhaled heparin improves outcomes in non-intubated COVID-19 patients

Inhaled unfractionated heparin significantly lowered the risk of intubation and death among hospitalised COVID-19 patients who did not require mechanical ventilation at baseline.

This analysis was based on the INHALE-HEP mate-trial (NCT04635241) [1], which Prof. Frank van Haren (St George Hospital, Australia) described as “a prospective pooled analysis of individual, de-identified patient-level data from multiple individual trials.” Trials were eligible if they were prospective, controlled, included an inhaled nebulised unfractionated heparin arm, and included adult patients hospitalised with confirmed COVID-19. Patients were excluded if they were intubated or required immediate intubation. In total, 6 trials with 478 participants were included [2].

Inhaled nebulised heparin showed a significant improvement in the primary outcome of intubation or death. 11.2% of participants receiving nebulised unfractionated heparin versus 22.4% of control participants reached the primary endpoint, corresponding to an OR of 0.43 (95% CI 0.26-0.73; P=0.001). Nebulised heparin also improved secondary outcomes, including intubation alone, in-hospital mortality, 28-day mortality, and hospital length of stay. No major bleeding, pulmonary bleeding, or heparin-induced thrombocytopenia was reported.

“In this meta-trial of 478 participants who were not intubated at baseline, inhaled nebulised unfractionated heparin was safe and significantly reduced intubation and mortality rates,” concluded Prof. van Haren.

1. van Haren F, et al. Br J Clin Pharmacol. 2021;87(8):3075-3091.

2. van Haren F, et al. Efficacy of inhaled nebulised unfractionated heparin to prevent intubation or death in hospitalised patients with COVID-19: a prospective international meta-trial of randomised clinical studies. ERS Congress, 27 September–1 October 2025, Amsterdam, the Netherlands.

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Posted on 30 October 2025