Full-dose blood thinners reduce need for organ support in moderately ill COVID patients

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In large clinical trials conducted worldwide, treating moderately hospitalized COVID-19 patients with full doses of anticoagulants reduced the need for ventilator and other organ support and was discharged. It has been shown that the possibilities have improved. However, using this treatment strategy in patients with severe COVID-19 who require intensive care did not achieve the same results. Formal conclusions from trials partially supported by the National Heart, Lung, Blood Institute (NHLBI), which is part of the National Institutes of Health, are displayed online. New England Journal of Medicine..

“These results provide a compelling example of how important it is to stratify patients with different disease severities. Clinical trial.. What may help one subgroup of patients may have any benefit or even harm in another, “said NHLBI Director Gary H. Gibbons, Medical Doctor.

The researchers are some people who died of COVID-19. Blood clot Even their smallest blood vessels were formed throughout their body. Antithrombotic drugs, including anticoagulants and anticoagulants, help prevent the formation of blood clots in certain diseases. During the course of COVID-19, doctors did not know which antithrombotic drug, what dose, and at what point the antithrombotic drug was effective. To answer these urgent questions, three international partners have come together to harmonize the study protocol with total or therapeutic and low or prophylactic doses of anticoagulant heparin in moderate and critically ill patients. I studied the effects of using heparin. Hospitalized with COVID-19.

Researchers defined patients with moderate illness as patients admitted with COVID-19 without the need for organ support, and severely ill patients as patients admitted with COVID-19. Intensive care Level of support, including respiratory and / or cardiovascular support.

In April 2020, hospitalized COVID-19 patients received low or full doses of heparin for up to 14 days after enrollment. By December 2020, interim results All doses of anticoagulant therapy did not reduce the need for organ support It can also be harmful to critically ill patients. But one month later, the interim results showed that: All doses of heparin probably benefited Patients with moderate illness.

“The formal conclusion from these studies is that the initiation of therapeutic anticoagulant therapy is beneficial for patients with moderate illness, and when patients develop severe COVID-19, anticoagulant therapy with heparin is used for this disease. It suggests that it may be too late to change the outcome, “said Dr. Judith Hockman. Accelerating COVID-19 Therapeutic Interventions and Vaccines-4, New York University Senior Vice-President of Clinical Sciences, Corresponding Author of Moderate Disease Studies, and NIH-funded study partnerACTIV-4) Antithrombotic inpatients. “The drugs evaluated by these trial Is familiar to physicians around the world and has wide access, making it highly applicable to patients with moderately ill COVID-19. “

The final analysis of the study data included 1,074 critically ill patients and 2,219 moderately ill patients. For both moderate and critically ill patients, researchers examined the period of no organ support by 21 days after enrollment. Among patients with moderate illness, researchers found that all doses of heparin were 99% more likely to reduce the need for organ support compared to patients who received low doses of heparin. Did. Although rare, a small number of patients experienced major bleeding. In critically ill patients, full-dose heparin also reduced the number of major thrombotic events, but reduced the need for organ support and increased the likelihood of early discharge after treatment. It never happened.

Participating trials include: Randomized, implantable, multifactorial adaptive platform trials for community pneumonia (REMAP-CAP) Therapeutic anticoagulant; antithrombotic therapy to improve the complications of COVID-19 (ATTACC); And ACTIV-4 antithrombotic inpatients. In the United States, ACTIV-4 antithrombotic inpatients are led in collaboration with several universities, including the Trial and Coordination Center Pittsburgh University, the Research Chairman’s Office and the Coordinating Center New York University. ACTIV-4 Antithrombotic Drugs Inpatients are also conducting another study to test the effects of adding antiplatelet drugs to anticoagulants.

“More work needs to be done to continue improving outcomes in COVID-19 patients,” said Matthew D. Neil, associate professor Roberta G. Simmons of the University of Pittsburgh, co-author of moderate illness. The doctor of medicine says. ACTIV-4 Antithrombotic drug research and co-chair of inpatients. “Given what we know about the types of blood clots in COVID-19 patients, anti-platelet drug testing is a particularly exciting approach.”

Early anticoagulant therapy that has been shown to reduce mortality in patients with moderately ill COVID-19

For more information:
Therapeutic anticoagulant therapy in critically ill patients with Covid-19 – Preliminary Report, New England Journal of Medicine (2021). DOI: 10.1056 / NEJMoa2105911

Quote: Full dose anticoagulants reduce the need for organ support in moderately ill COVID patients (August 4, 2021). -ill.html

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