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Full-Dose Blood Thinners Improve Clinical Outcomes in Moderate COVID-19 Cases

Moderately ill patients hospitalized with COVID-19 were less likely to require life support after receiving full-dose anticoagulation treatment, according to interim results of a multiplatform randomized trial.

Full-dose blood thinners improved outcomes for patients hospitalized with moderate coronavirus disease 2019 (COVID-19), interim results of a multiplatform randomized trial found, the National Institutes of Health reported in a news release.

The study includes three clinical trial platforms involving more than 1000 patients hospitalized with moderate COVID-19 at more than 300 hospitals across 5 continents. Moderately ill patients who received full-dose heparin anticoagulation treatments were less likely to require life support such as ventilation. A possible reduction in mortality is also being studied.

“Just as the use of steroids has become a mainstay in terms of treating hospitalized patients with COVID-19, I think high-dose blood thinners will follow the same sort of path,” Jeffery Berger, MD, co-principal investigator of the Accelerating COVID-19 Therapeutic Interventions and Vaccines-4a (ACTIV-4a) trial and director of the Center for the Prevention of Cardiovascular Disease at NYU Langone Health, told Contagion®. “I think this will change how patients are treated when they become hospitalized for this infection. To be honest, I think that in an era when hospitals are being overrun and patients are getting sicker and ICUs are getting fuller, I think a study like this provides a lot of hope that we will be able to lessen the severity and the horrible impact of this disease.”

Full doses of blood thinners were found to be safe and superior to standard dosing given to prevent blood clots among hospitalized patients. Investigators are working to make the full trial results available in the coming weeks.

Early in the pandemic, health care providers noticed a prominence of thrombotic events, including blood clots in legs and lungs, heart attacks, strokes, and micro-thrombotic events in small arteries and veins. Investigators hypothesized that reducing blood clots would lessen disease severity.

In December, the group halted enrollment of critically ill COVID-19 patients after finding that use of high-dose blood thinners among that group was not beneficial and may have been harmful. The study continued among moderately ill COVID-19 patients, with more promising results emerging for that group.

"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," Judith Hochman, MD, chair of the ACTIV-4a platform and the Harold Snyder Family Professor & Associate Director of Cardiology, Senior Associate Dean for Clinical Sciences and Co-Director, NYU-HHC Clinical and Translational Science Institute, NYU Grossman School of Medicine, said in a statement.

Berger said the study suggests that COVID-19 patients should receive full-dose blood thinners within the first 72 hours of hospitalization and possibly even before hospitalization. Patients in the study remained on the drug for up to 14 days or until discharge from the hospital.

“It’s important to note that this is sort of topline results and we are in the midst of doing a deep dive into all the different subgroups to get a better understanding of the data,” Berger said.

Along with the ACTIV-4a platform, the study includes the Randomized, Embedded, Multi-factorial Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP) and Antithrombotics Inpatient; and Antithrombotic Therapy to Ameliorate Complications of COVID-19 (ATTACC).

“Patients should feel assured that there was tremendous diligence in the details and a significant amount of oversight to make sure that we were dealing with all potential issues,” Berger said. “It just shows that when there is significant urgency, people can work together for the common good and make substantial changes and they can have a global impact. I feel very honored and excited to be a part of that team.”

Previous studies have examined the potential use of blood thinners for prevention or early treatment of COVID-19. Investigators at Rensselaer Polytechnic Institute (RPI) have examined whether heparin, which is also available in non-anticoagulant formulations, could interfere with SARS-CoV-E infection by binding to the coronavirus’ surface spike protein. Another study, using data from the Mount Sinai COVID Informatics Center, linked anticoagulants with improved COVID-19 survival rates.