Anticoagulation can increase the rate of survival in patients hospitalised with moderate COVID-19

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Three trials have shown that for those patients hospitalised with moderate COVID-19, anticoagulation with heparin might reduce the need for organ support and increase survival compared with usual care.

Despite this, if patients were already critically ill with COVID-19, anticoagulation therapy didn’t improve outcomes.

“Anticoagulation can increase the rate of survival in patients hospitalised with moderate COVID-19.“

The findings from three integrated platform trials - Accelerating COVID-19 Therapeutic Interventions and Vaccines-4 (ACTIV-4), the Randomised, Embedded, Multi-factorial Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP) and Antithrombotic Therapy to Ameliorate Complications of COVID-19 (ATTACC) – were published on 4 August 2021, in The New England Journal of Medicine.

Patients who were not critically ill but were hospitalised with COVID-19 were randomly assigned to regiments of either the usual care pharmacologic thromboprophylaxis, therapeutic-dose anticoagulation with heparin or most commonly low-molecular-weight heparin. When pre-specified criteria for the dominance of therapeutic dose anticoagulation was encountered, the trial stopped.

The final analysis found that anticoagulation with heparin increased the number of organ support-free days by 98.6% as compared to conventional therapy in 2,219 patients with moderate illness across 121 sites in 9 countries, including the United Kingdom (adjusted odds ratio, 1.27; 95 per cent credible interval, 1.03 to 1.58).

UK chief investigator for REMAP-CAP and professor of critical care at Imperial College London, Anthony Gordon, stated: “This new evidence from less severely ill patients, when combined with the results in critically ill patients, demonstrates the importance of evaluating treatments in randomised clinical trials. This is the only way to learn what are the right treatments but also ensure we treat the right patients at the right time.”

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