Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 79, Issue 9, Pages 917-928Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2021.12.023
Keywords
anticoagulation; clinical trial; coagulopathy; COVID-19
Categories
Funding
- Amgen
- Novo Nordisk
- Novartis
- Canadian Institutes of Health Research
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COVID-19 is associated with thromboembolic disease. Anticoagulation therapy may play a role in patients who do not require intensive care unit support.
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) (c) 2022 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
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