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

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 smal...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2022-03, Vol.79 (9), p.917-928
Main 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
Format: Article
Language:English
Subjects:
Anticoagulants - therapeutic use
COVID-19 - complications
COVID-19 - therapy
Critical Care
Enoxaparin - therapeutic use
Hospitalization
Humans
Pyrazoles - therapeutic use
Pyridones - therapeutic use
Thromboembolism - prevention & control
Thromboembolism - virology
Thrombosis - prevention & control
Thrombosis - virology
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Summary: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).
ISSN:1558-3597
DOI:10.1016/j.jacc.2021.12.023