tetano
Editor, Senior Moderator
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[SUP] 1 [/SUP], Gregg W Stone[SUP] 2 [/SUP], Anuradha Lala[SUP] 3 [/SUP], Emilia Bagiella[SUP] 4 [/SUP], Pedro R Moreno[SUP] 5 [/SUP], Girish N Nadkarni[SUP] 6 [/SUP], Ori Ben-Yehuda[SUP] 7 [/SUP], Juan F Granada[SUP] 7 [/SUP], Ovidiu Dressler[SUP] 8 [/SUP], Elizabeth O Tinuoye[SUP] 5 [/SUP], Carlos Granada[SUP] 9 [/SUP], Jessica Bustamante[SUP] 5 [/SUP], Carlos Peyra[SUP] 5 [/SUP], Lucas C Godoy[SUP] 10 [/SUP], Igor F Palacios[SUP] 11 [/SUP], Valentin Fuster[SUP] 12 [/SUP]
Affiliations
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.
. 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[SUP] 1 [/SUP], Gregg W Stone[SUP] 2 [/SUP], Anuradha Lala[SUP] 3 [/SUP], Emilia Bagiella[SUP] 4 [/SUP], Pedro R Moreno[SUP] 5 [/SUP], Girish N Nadkarni[SUP] 6 [/SUP], Ori Ben-Yehuda[SUP] 7 [/SUP], Juan F Granada[SUP] 7 [/SUP], Ovidiu Dressler[SUP] 8 [/SUP], Elizabeth O Tinuoye[SUP] 5 [/SUP], Carlos Granada[SUP] 9 [/SUP], Jessica Bustamante[SUP] 5 [/SUP], Carlos Peyra[SUP] 5 [/SUP], Lucas C Godoy[SUP] 10 [/SUP], Igor F Palacios[SUP] 11 [/SUP], Valentin Fuster[SUP] 12 [/SUP]
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.