NEJM: Anticoagulants help moderately ill COVID-19 patients

Moderately ill patients hospitalized with COVID-19 have better chances of survival if treated with therapeutic-dose anticoagulation, according to an international study involving 121 sites, including UT Southwestern Medical Center.

Moderately ill COVID-19 patients treated with therapeutic-dose anticoagulation with unfractionated or low molecular-weight heparin were 27% less likely to need cardiovascular respiratory organ support such as intubation, said Ambarish Pandey, M.D., Assistant Professor of Internal Medicine at UT Southwestern, who served as site investigator and co-author of the study reported in The New England Journal of Medicine. Moderately ill patients had a 4% increased chance of survival until discharge without requiring organ support with anticoagulants, according to the study involving 2,200 patients.

“The 4% increase in survival to discharge without needing organ support represents a very meaningful clinical improvement in these patients,” said Dr. Pandey, a Texas Health Resources Clinical Scholar who specializes in preventive cardiology and heart failure with preserved ejection fraction. “If we treat 1,000 patients who are hospitalized with COVID-19 with moderate illness, an additional 40 patients would have meaningful improvement in clinical status.”

Participating platforms for the study, which defined moderately ill patients as those who did not need intensive care unit-level support, included Antithrombotic Therapy to Ameliorate Complications of COVID-19 (ATTACC); A Multicenter, Adaptive, Randomized Controlled Platform Trial of the Safety and Efficacy of Antithrombotic Strategies in Hospitalized Adults with COVID-19 (ACTIV-4a); and Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP). Comparisons between the three platforms are provided in the supplementary appendix, available with the full text of the article at NEJM.org.

A parallel study in The New England Journal of Medicine found that therapeutic-dose anticoagulation did not help severely ill patients.