Efficacy and Safety of Therapeutic-Dose Heparin vs Standard Prophylactic or Intermediate-Dose Heparins for Thromboprophylaxis in High-risk Hospitalized Patients With COVID-19: The HEP-COVID Randomized Clinical Trial

SPS commentary:

An editorial discusses this and similar studies, comparing and contrasting their findings and notes that despite some methodological differences, they do provide important conclusions concerning the efficacy and safety of anticoagulant therapy in hospitalised patients with COVID-19. First, therapeutic anticoagulation with low molecular weight or unfractionated heparin is associated with improved outcomes in hospitalised patients with COVID-19 who are not critically ill or in ICU setting, particularly those patients with elevated D-dimer levels. Second, the data also indicate patients who are critically ill and/or in the ICU do not benefit from therapeutic anticoagulation and manifest an increased risk for bleeding compared with patients receiving prophylactic-dose anticoagulation. The beneficial effect of therapeutic anticoagulation is diminished and the risk of haemorrhage is increased in patients with progressively more severe disease, potentially related to hyperinflammation, endothelial disruption, platelet activation, and coagulopathy. Third, none of the studies would support the use of an anticoagulant administered at a dose between prophylactic and therapeutic, whether for ICU or non-ICU patients.