Anticoagulation in Patients With COVID-19: JACC Review Topic of the Week.

Link: https://doi.org/S0735-1097(22)00007-9
Authors: Farkouh, Michael E; Stone, Gregg W; Lala, Anuradha; Bagiella, Emilia; Moreno, Pedro R; Nadkarni, Girish N; Ben-Yehuda, Ori; Granada, Juan F; Dressler, Ovidiu; Tinuoye, Elizabeth O; Granada, Carlos; Bustamante, Jessica; Peyra, Carlos; Godoy, Lucas C; Palacios, Igor F; Fuster, Valentin

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).