Therapeutic Anticoagulation in COVID-19 Patients

Treating moderately ill hospitalized COVID-19 patients with therapeutic-dose anticoagulation with heparin increased the probability of survival.

USA: An initial strategy of therapeutic-dose anticoagulation with heparin in noncritically ill patients with Covid-19 increases the chances of survival, according to a recent study. The strategy also reduced the use of cardiovascular or respiratory organ support versus usual-care thromboprophylaxis.

The international study, published in the New England Journal of Medicine, involved 121 sites, including UT Southwestern Medical Center.

Moderately ill COVID-19 patients treated with therapeutic-dose anticoagulation with unfractionated or low molecular-weight heparin were 27% less likely to need cardiovascular respiratory organ support such as intubation, said Ambarish Pandey, M.D., Assistant Professor of Internal Medicine at UT Southwestern, who served as site investigator and co-author of the study. Moderately ill patients had a 4% increased chance of survival until discharge without requiring organ support with anticoagulants, according to the study involving 2,200 patients.

"The 4% increase in survival to discharge without needing organ support represents a very meaningful clinical improvement in these patients," said Dr. Pandey, a Texas Health Resources Clinical Scholar who specializes in preventive cardiology and heart failure with preserved ejection fraction. "If we treat 1,000 patients who are hospitalized with COVID-19 with moderate illness, an additional 40 patients would have a meaningful improvement in clinical status."

Participating platforms for the study, which defined moderately ill patients as those who did not need intensive care unit-level support, included:

• Antithrombotic Therapy to Ameliorate Complications of COVID-19 (ATTACC)
• A Multicenter, Adaptive, Randomized Controlled Platform Trial of the Safety and Efficacy of Antithrombotic Strategies in Hospitalized Adults with COVID-19 (ACTIV-4a)
• Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP)

Comparisons between the three platforms are provided in the supplementary appendix, available with the full text of the article at NEJM.org.

A parallel study in The New England Journal of Medicine found that therapeutic-dose anticoagulation did not help severely ill patients.

Reference

The study titled, "Therapeutic Anticoagulation with Heparin in Noncritically Ill Patients with Covid-19," is published in the New England Journal of Medicine.

DOI: https://www.nejm.org/doi/full/10.1056/NEJMoa2105911