Godoy, Lucas C; Neal, Matthew D; Goligher, Ewan C; Cushman, Mary; Houston, Brett L; Bradbury, Charlotte A; McQuilten, Zoe K; Tritschler, Tobias; Kahn, Susan R; Berry, Lindsay R; Lorenzi, Elizabeth; Jensen, Tom; Higgins, Alisa M; Kornblith, Lucy Z; Berger, Jeffrey S; Gong, Michelle N; Paul, Jonathan D; Castellucci, Lana A; Le Gal, Grégoire; Lother, Sylvain A; ... (2024). Heparin Dose Intensity and Organ Support-Free Days in Patients Hospitalized for COVID-19. JACC. Advances., 3(100780) Elsevier 10.1016/j.jacadv.2023.100780
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BACKGROUND
Clinical trials suggest that therapeutic-dose heparin may prevent critical illness and vascular complications due to COVID-19, but knowledge gaps exist regarding the efficacy of therapeutic heparin including its comparative effect relative to intermediate-dose anticoagulation.
OBJECTIVES
The authors performed 2 complementary secondary analyses of a completed randomized clinical trial: 1) a prespecified per-protocol analysis; and 2) an exploratory dose-based analysis to compare the effect of therapeutic-dose heparin with low- and intermediate-dose heparin.
METHODS
Patients who received initial anticoagulation dosed consistently with randomization were included. The primary outcome was organ support-free days (OSFDs), a combination of in-hospital death and days free of organ support through day 21.
RESULTS
Among 2,860 participants, 1,761 (92.8%) noncritically ill and 857 (89.1%) critically ill patients were treated per-protocol. Among noncritically ill per-protocol patients, the posterior probability that therapeutic-dose heparin improved OSFDs as compared with usual care was 99.3% (median adjusted OR: 1.36; 95% credible interval [CrI]: 1.07-1.74). Therapeutic heparin had a high posterior probability of efficacy relative to both low- (94.6%; adjusted OR: 1.26; 95% CrI: 0.95-1.64) and intermediate- (99.8%; adjusted OR: 1.80; 95% CrI: 1.22-2.62) dose thromboprophylaxis. Among critically ill per-protocol patients, the posterior probability that therapeutic heparin improved outcomes was low.
CONCLUSIONS
Among noncritically ill patients hospitalized for COVID-19 who were randomized to and initially received therapeutic-dose anticoagulation, heparin, compared with usual care, was associated with improved OSFDs, a combination of in-hospital death and days free of organ support. Therapeutic heparin appeared superior to both low- and intermediate-dose thromboprophylaxis.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine |
UniBE Contributor: |
Tritschler, Tobias |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2772-963X |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
30 Jun 2024 20:36 |
Last Modified: |
30 Jun 2024 20:45 |
Publisher DOI: |
10.1016/j.jacadv.2023.100780 |
PubMed ID: |
38938844 |
Uncontrolled Keywords: |
COVID-19 anticoagulation clinical trial heparin thrombosis |
BORIS DOI: |
10.48350/198300 |
URI: |
https://boris.unibe.ch/id/eprint/198300 |
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