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Heparin Dose Intensity and Organ Support-Free Days in Patients Hospitalized for COVID-19
Lucas C Godoy1,2,3, Matthew D Neal4, Ewan C Goligher2,5
1Peter Munk Cardiac Centre at the University Health Network, Toronto, Ontario, Canada.
JACC. Advances
|June 28, 2024
Summary
Therapeutic-dose heparin improved outcomes for noncritically ill COVID-19 patients, increasing organ support-free days. This treatment showed superiority over low- and intermediate-dose heparin for these patients.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Infectious Diseases
Background:
- Clinical trials indicate therapeutic-dose heparin may prevent critical illness and vascular complications in COVID-19 patients.
- Knowledge gaps persist regarding the comparative efficacy of therapeutic heparin versus intermediate-dose anticoagulation.
Purpose of the Study:
- To compare the efficacy of therapeutic-dose heparin against low- and intermediate-dose heparin.
- To analyze outcomes based on heparin dosage in COVID-19 patients.
Main Methods:
- Secondary analyses of a completed randomized clinical trial were conducted.
- Included patients receiving initial anticoagulation consistent with randomization.
- Primary outcome measured was organ support-free days (OSFDs) through day 21.
Main Results:
- Among noncritically ill patients treated per-protocol, therapeutic heparin showed a 99.3% probability of improving OSFDs compared to usual care.
- Therapeutic heparin demonstrated high probability of efficacy over low-dose (94.6%) and intermediate-dose (99.8%) thromboprophylaxis.
- Critically ill patients showed a low probability of improved outcomes with therapeutic heparin.
Conclusions:
- Therapeutic-dose heparin improved OSFDs in noncritically ill COVID-19 patients compared to usual care.
- Heparin at therapeutic doses appeared superior to both low- and intermediate-dose thromboprophylaxis in this patient group.
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