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J Am Coll Cardiol
. 2022 Mar 8;79(9):917-928.
doi: 10.1016/j.jacc.2021.12.023.
Anticoagulation in Patients With COVID-19: JACC Review Topic of the Week
Michael E Farkouh 1 , Gregg W Stone 2 , Anuradha Lala 3 , Emilia Bagiella 4 , Pedro R Moreno 5 , Girish N Nadkarni 6 , Ori Ben-Yehuda 7 , Juan F Granada 7 , Ovidiu Dressler 8 , Elizabeth O Tinuoye 5 , Carlos Granada 9 , Jessica Bustamante 5 , Carlos Peyra 5 , Lucas C Godoy 10 , Igor F Palacios 11 , Valentin Fuster 12
Affiliations
- PMID: 35241226
- DOI: 10.1016/j.jacc.2021.12.023
Abstract
Clinical, laboratory, and autopsy findings support an association between coronavirus disease-2019 (COVID-19) and thromboembolic disease. Acute COVID-19 infection is characterized by mononuclear cell reactivity and pan-endothelialitis, contributing to a high incidence of thrombosis in large and small blood vessels, both arterial and venous. Observational studies and randomized trials have investigated whether full-dose anticoagulation may improve outcomes compared with prophylactic dose heparin. Although no benefit for therapeutic heparin has been found in patients who are critically ill hospitalized with COVID-19, some studies support a possible role for therapeutic anticoagulation in patients not yet requiring intensive care unit support. We summarize the pathology, rationale, and current evidence for use of anticoagulation in patients with COVID-19 and describe the main design elements of the ongoing FREEDOM COVID-19 Anticoagulation trial, in which 3,600 hospitalized patients with COVID-19 not requiring intensive care unit level of care are being randomized to prophylactic-dose enoxaparin vs therapeutic-dose enoxaparin vs therapeutic-dose apixaban. (FREEDOM COVID-19 Anticoagulation Strategy [FREEDOM COVID]; NCT04512079).
Keywords: COVID-19; anticoagulation; clinical trial; coagulopathy.