Does Therapeutic Anticoagulation Improve Outcomes in Hospitalized Patients with COVID-19?

In an adaptive multiplatform trial, therapeutic anticoagulation with heparin was associated with no benefit in critically ill patients and minimal benefit in noncritically ill patients.

The association of COVID-19 with a dysregulated inflammatory cascade and excess risk for thrombotic events led to the hypothesis that therapeutic-dose anticoagulation might be of clinical benefit. Investigators integrated the platforms from three large trials designed to examine the benefit of therapeutic-dose anticoagulation with heparin compared with pharmacologic thromboprophylaxis in hospitalized patients with COVID-19 who were critically ill (i.e., required intensive care unit–level care) or noncritically ill. In one trial (ATTACC), patients were conventionally randomized; the other two (REMAP-CAP and ACTIV-4a) utilized response-adaptive randomization. The primary outcome was days without organ support.

Of 1207 critically ill patients a…

Reviewing Author

Hana M. El Sahly, MD

Disclosures

Grant/Research SupportNational Institutes of Health

Hana M. El Sahly, MD

Disclosures

Grant/Research SupportNational Institutes of Health

Does Therapeutic Anticoagulation Improve Outcomes in Hospitalized Patients with COVID-19?

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Reviewing Author