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Updated: Oct 1, 2025
Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood
Published on: October 12, 2012
Anticoagulation in Patients With COVID-19: JACC Review Topic of the Week
Michael E Farkouh1, Gregg W Stone2, Anuradha Lala3
1Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Insights
Coronavirus disease 2019 (COVID-19) is linked to blood clots. The FREEDOM COVID trial investigates if higher doses of anticoagulation improve outcomes for hospitalized COVID-19 patients not in intensive care.
Area of Science:
- Medical Research
- Cardiovascular Science
- Infectious Diseases
Background:
- COVID-19 is associated with a high incidence of thrombosis due to mononuclear cell reactivity and pan-endothelialitis.
- While therapeutic heparin showed no benefit in critically ill COVID-19 patients, some evidence suggests a role in less severe cases.
- Understanding the pathology and evidence for anticoagulation in COVID-19 is crucial.
Purpose of the Study:
- To evaluate the efficacy of different anticoagulation strategies in hospitalized COVID-19 patients not requiring intensive care.
- To compare prophylactic enoxaparin with therapeutic enoxaparin and therapeutic apixaban.
Main Methods:
- The FREEDOM COVID-19 Anticoagulation trial randomizes 3,600 hospitalized patients with COVID-19.
- Patients are not requiring intensive care unit level of care.
- The trial compares prophylactic-dose enoxaparin versus therapeutic-dose enoxaparin versus therapeutic-dose apixaban.
Main Results:
- This section will report findings from the FREEDOM COVID trial once available.
- The study aims to determine if therapeutic anticoagulation improves outcomes compared to prophylactic doses.
Conclusions:
- The FREEDOM COVID trial is actively investigating optimal anticoagulation strategies for non-critically ill hospitalized COVID-19 patients.
- Results will inform clinical practice regarding the use of enoxaparin and apixaban in this population.
Abstract:
Clinical, laboratory, and autopsy findings support an association between coronavirus disease-2019 (COVID-19) and thromboembolic disease. Acute COVID-19 infection is characterized by mononuclear cell reactivity and pan-endothelialitis, contributing to a high incidence of thrombosis in large and small blood vessels, both arterial and venous. Observational studies and randomized trials have investigated whether full-dose anticoagulation may improve outcomes compared with prophylactic dose heparin. Although no benefit for therapeutic heparin has been found in patients who are critically ill hospitalized with COVID-19, some studies support a possible role for therapeutic anticoagulation in patients not yet requiring intensive care unit support. We summarize the pathology, rationale, and current evidence for use of anticoagulation in patients with COVID-19 and describe the main design elements of the ongoing FREEDOM COVID-19 Anticoagulation trial, in which 3,600 hospitalized patients with COVID-19 not requiring intensive care unit level of care are being randomized to prophylactic-dose enoxaparin vs therapeutic-dose enoxaparin vs therapeutic-dose apixaban. (FREEDOM COVID-19 Anticoagulation Strategy [FREEDOM COVID]; NCT04512079).
