In non-severe COVID-19 patients, an initial therapeutic strategy with heparin increases the chance of survival after discharge and reduces the need for respiratory and cardiovascular support compared against usual thromboprophylaxis doses.
These data have been welcomed by a medical community eager to receive good news in terms of effective strategies to combat an already existing infection, for months now.
This study had an unusual design, since it was essential for it to adapt to these virus dynamics.
It was an open study, multiplatform, controlled and randomized, on non-critical COVID-19 patients (defined as the absence of critical support to any organ at randomization). Randomization was to receiving pragmatic doses of anticoagulation with heparin vs. usual thromboprophylaxis doses.
Primary end point was vital organ-support freedom combined with inhospital death. This end point was analyzed using the Bayesian statistical model, according to the baseline d-dimer level.
This study was stopped when the prespecified criterion for anticoagulant dose superiority was met.
Among the 2,219 patients who were finally included in this analyzis, the probability that therapeutic-dose anticoagulation increased organ support-freedom as compared against usual-care thromboprophylaxis was 98.6% (adjusted OR, 1.27; 95% CI, 1.03 to 1.58). The adjusted absolute between-group difference in survival until hospital discharge without organ support favoring therapeutic-dose anticoagulation was 4%.
Read also: How Bad is Malapposition? OCT Findings and Events.
The advantage was even more important when looking at the high d-dimer cohort.
Major bleeding occurred in 1.9% of patients receiving therapeutic-dose anticoagulation vs 0.9% of those receiving thromboprophylaxis.
Conclusion
An anticoagulation scheme with heparin in non-critical COVID-19 patients is superior to the thromboprophylaxis scheme in terms of survival and respiratory and cardiovascular vital support.
nejmoa2105911Original Title: Therapeutic Anticoagulation with Heparin in Noncritically Ill Patients with Covid-19. The ATTACC, ACTIV-4a, and REMAP-CAP Investigators.
Rerference: Patrick R Lawler et al. N Engl J Med . 2021 Aug 4. Online ahead of print.
doi: 10.1056/NEJMoa2105911.
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