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In noncritical COVID-19, therapeutic vs. prophylactic anticoagulation did not reduce a composite adverse clinical

Thomas G DeLoughery1

  • 1Oregon Health & Science University, Portland, Oregon, USA (T.G.D.).

Annals of Internal Medicine
|July 31, 2023
PubMed

Insights

For noncritically ill patients hospitalized with COVID-19, a standard prophylactic dose of anticoagulation did not significantly reduce thrombotic events compared to therapeutic doses. This finding impacts current treatment guidelines for COVID-19 patients.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Thrombosis Research

Background:

  • COVID-19 is associated with a hypercoagulable state, increasing the risk of thrombotic events.
  • Optimal anticoagulation strategies for noncritically ill hospitalized patients with COVID-19 remain uncertain.
  • Previous studies have yielded conflicting results regarding the benefits of different anticoagulation intensities.

Purpose of the Study:

  • To compare the efficacy and safety of therapeutic-intensity anticoagulation versus standard prophylactic-intensity anticoagulation in noncritically ill patients hospitalized with COVID-19.
  • To determine the optimal anticoagulation strategy to prevent major thrombotic events in this patient population.
  • To evaluate the impact of anticoagulation intensity on bleeding complications.

Main Methods:

  • A randomized, open-label trial involving noncritically ill patients hospitalized with COVID-19.
  • Patients were randomly assigned to receive either therapeutic-intensity anticoagulation or standard prophylactic-intensity anticoagulation.
  • The primary outcome was a composite of major thrombotic events, including venous thromboembolism and arterial thrombosis.

Main Results:

  • There was no significant difference in the rate of major thrombotic events between the therapeutic-intensity anticoagulation group and the prophylactic-intensity anticoagulation group.
  • Bleeding events were more frequent in the therapeutic-intensity anticoagulation group compared to the prophylactic-intensity group.
  • Specific subgroup analyses did not reveal significant benefits for therapeutic anticoagulation.

Conclusions:

  • For noncritically ill patients hospitalized with COVID-19, standard prophylactic-dose anticoagulation is not inferior to therapeutic-dose anticoagulation in preventing thrombotic events.
  • Therapeutic-intensity anticoagulation is associated with a higher risk of bleeding in this population.
  • These findings suggest that prophylactic-intensity anticoagulation should be considered the standard of care for noncritically ill hospitalized COVID-19 patients.
Abstract

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