COVID-19 · Anticoagulation in COVID-19
Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19
| Design | Open-label adaptive multiplatform randomised trial, stopped for futility |
|---|---|
| Treatment | Therapeutic-dose anticoagulation with heparin |
| Control | Usual-care pharmacological thromboprophylaxis |
| Population | 1098 critically ill patients with COVID-19 |
| Follow-up | Hospital discharge |
| Primary endpoint | Organ support-free days to day 21 |
| Result | Median organ support-free days was 1 (IQR -1 to 16) with therapeutic-dose anticoagulation, with no greater probability of survival to hospital discharge or of organ support-free days than usual-care thromboprophylaxis. The trial was stopped when the prespecified futility criterion was met. |
| Secondary endpoints | Survival to hospital discharge, major bleeding, thrombotic events |
In critically ill patients with Covid-19, an initial strategy of therapeutic-dose anticoagulation with heparin did not result in a greater probability of survival to hospital discharge or a greater number of days free of cardiovascular or respiratory organ support than did usual-care pharmacologic thromboprophylaxis.
The trial authors, in the published abstract
A necessary correction to the widespread empirical escalation of anticoagulation during the early pandemic, driven by observed thrombosis rates. The same platform found a different answer in moderately ill patients, which is the reason severity stratification appears in every subsequent recommendation.
Goligher EC, Bradbury CA, McVerry BJ, et al. Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19. N Engl J Med 2021 Aug 26;385(9):777-789.