Table 6a. Anticoagulant Therapy: Selected Clinical Trial Data

Last Updated: February 29, 2024

The clinical trials described in this table do not represent all the trials that the Panel reviewed while developing the recommendations for anticoagulant therapy. The studies summarized below are those that have had the greatest impact on the Panel’s recommendations.

Table 6a. Anticoagulant Therapy: Selected Clinical Trial Data
Table 6a. Anticoagulant Therapy: Selected Clinical Trial Data

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References

ATTACC, ACTIV-4a, and REMAP-CAP Investigators. Therapeutic anticoagulation with heparin in noncritically ill patients with COVID-19. N Engl J Med. 2021;385(9):790-802. Available at: https://www.ncbi.nlm.nih.gov/pubmed/34351721.
Sholzberg M, Tang GH, Rahhal H, et al. Effectiveness of therapeutic heparin versus prophylactic heparin on death, mechanical ventilation, or intensive care unit admission in moderately ill patients with COVID-19 admitted to hospital: RAPID randomised clinical trial. BMJ. 2021;375:n2400. Available at: https://www.ncbi.nlm.nih.gov/pubmed/34649864.
Spyropoulos AC, Goldin M, Giannis D, et al. 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. JAMA Intern Med. 2021;181(12):1612-1620. Available at: https://www.ncbi.nlm.nih.gov/pubmed/34617959.
Lopes RD, de Barros E Silva PGM, Furtado RHM, et al. Therapeutic versus prophylactic anticoagulation for patients admitted to hospital with COVID-19 and elevated D-dimer concentration (ACTION): an open-label, multicentre, randomised, controlled trial. Lancet. 2021;397(10291):2253-2263. Available at: https://www.ncbi.nlm.nih.gov/pubmed/34097856.
Stone GW, Farkouh ME, Lala A, et al. Randomized trial of anticoagulation strategies for noncritically ill patients hospitalized with COVID-19. J Am Coll Cardiol. 2023;81(18):1747-1762. Available at: https://pubmed.ncbi.nlm.nih.gov/36889611.
Bohula EA, Berg DD, Lopes MS, et al. Anticoagulation and antiplatelet therapy for prevention of venous and arterial thrombotic events in critically ill patients with COVID-19: COVID-PACT. Circulation. 2022;146(18):1344-1356. Available at: https://www.ncbi.nlm.nih.gov/pubmed/36036760.
REMAP-CAP, ACTIV-4a, and ATTACC Investigators. Therapeutic anticoagulation with heparin in critically ill patients with COVID-19. N Engl J Med. 2021;385(9):777-789. Available at: https://www.ncbi.nlm.nih.gov/pubmed/34351722.
INSPIRATION Investigators. Effect of intermediate-dose vs standard-dose prophylactic anticoagulation on thrombotic events, extracorporeal membrane oxygenation treatment, or mortality among patients with COVID-19 admitted to the intensive care unit: the INSPIRATION randomized clinical trial. JAMA. 2021;325(16):1620-1630. Available at: https://www.ncbi.nlm.nih.gov/pubmed/33734299.
Labbé V, Contou D, Heming N, et al. Effects of standard-dose prophylactic, high-dose prophylactic, and therapeutic anticoagulation in patients with hypoxemic COVID-19 pneumonia: the ANTICOVID randomized clinical trial. JAMA Intern Med. 2023;183(6):520-531. Available at: https://pubmed.ncbi.nlm.nih.gov/36946232.
Connors JM, Brooks MM, Sciurba FC, et al. Effect of antithrombotic therapy on clinical outcomes in outpatients with clinically stable symptomatic COVID-19: the ACTIV-4B randomized clinical trial. JAMA. 2021;326(17):1703-1712. Available at: https://www.ncbi.nlm.nih.gov/pubmed/34633405.
Barco S, Voci D, Held U, et al. Enoxaparin for primary thromboprophylaxis in symptomatic outpatients with COVID-19 (OVID): a randomised, open-label, parallel-group, multicentre, Phase 3 trial. Lancet Haematol. 2022;9(8):e585-e593. Available at: https://www.ncbi.nlm.nih.gov/pubmed/35779558.
Cools F, Virdone S, Sawhney J, et al. Thromboprophylactic low-molecular-weight heparin versus standard of care in unvaccinated, at-risk outpatients with COVID-19 (ETHIC): an open-label, multicentre, randomised, controlled, Phase 3b trial. Lancet Haematol. 2022;9(8):e594-e604. Available at: https://www.ncbi.nlm.nih.gov/pubmed/35779560.
Wang TY, Wahed AS, Morris A, et al. Effect of thromboprophylaxis on clinical outcomes after COVID-19 hospitalization. Ann Intern Med. 2023;176(4):515-523. Available at: https://pubmed.ncbi.nlm.nih.gov/36940444.
Ramacciotti E, Barile Agati L, Calderaro D, et al. Rivaroxaban versus no anticoagulation for post-discharge thromboprophylaxis after hospitalisation for COVID-19 (MICHELLE): an open-label, multicentre, randomised, controlled trial. Lancet. 2022;399(10319):50-59. Available at: https://www.ncbi.nlm.nih.gov/pubmed/34921756.