Manitoba, Canada—Full-dose anticoagulation treatment given to moderately ill patients hospitalized for COVID-19 is showing promise for reducing the need for vital organ support, such as mechanical ventilation.

Early trial results also hold out hope that mortality rates could be reduced, according to the researchers.

Since May 2020, three clinical trial platforms involving more than 300 hospitals in five continents have worked together to urgently test whether there is a greater benefit to full doses of heparin to treat adults hospitalized for noncritical COVID-19 illness compared with the lower dose usually administered to prevent blood clots in hospitalized patients.

Interim results based on treatment of more than 1,300 inpatients with moderate—not severe—COVID-19 suggest that full doses of blood thinners were safe and more effective than doses normally given to prevent blood clots in hospitalized patients. For purposes of the study, moderately ill patients were defined as those not receiving critical care or organ support at trial enrollment.

Late last year, the group announced that routine use of full-dose anticoagulation when started in the ICU in critically ill COVID-19 patients was not beneficial and appeared to be harmful. 

“In a disease with a limited number of effective therapies, our results have the potential to define a new standard of care for moderately ill hospitalized COVID-19 patients around the world,” said Ryan Zarychanski, MD, MSc, of the University of Manitoba and chair of the Antithrombotic Therapy to Ameliorate Complications of COVID-19 (ATTACC) platform and of the therapeutic anticoagulation domain of the Randomized, Embedded, Multi-factorial Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP).

The research was prompted by the observation of increased rates of blood clots and inflammation among COVID-19 patients. Multiple organs were affected, which led to complications such as lung failure, heart attack, and stroke. Questions were raised about whether increased doses of blood thinners would be helpful or harmful.

“These results are very exciting and lead us to better understand the impact of applying the right therapies at the right time in the course of this challenging disease,” said Judith Hochman, MD, chair of Accelerating COVID-19 Therapeutic Interventions and Vaccines-4 (ACTIV-4) platform, at the NYU Grossman School of Medicine in New York.

More information about medications that might be beneficial for COVID-19 are expected from the consortium. The adaptive protocol has been designed to allow different drugs to be started, stopped, or combined during the study in response to emerging scientific data. The approach enables the rapid testing of additional agents without compromising safety, according to the researchers.  

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