ISTH guidelines for antithrombotic treatment in COVID-19

Article Cardiac & Cardiovascular Systems

The Association of Low Molecular Weight Heparin Use and In-hospital Mortality Among Patients Hospitalized with COVID-19

Lan Shen et al.

Summary: The study found that the use of LMWH in hospitalized COVID-19 patients was associated with lower all-cause in-hospital mortality compared to non-LMWH users, especially among more severely ill patients.

CARDIOVASCULAR DRUGS AND THERAPY (2022)

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Article Medicine, General & Internal

Low in-hospital mortality rate in patients with COVID-19 receiving thromboprophylaxis: data from the multicentre observational START-COVID Register

Daniela Poli et al.

Summary: This retrospective observational study on COVID-19 patients found that heparin treatment is significantly associated with reduced mortality rates, especially in patients older than 59 years. Additionally, the use of antithrombotic drugs during hospital stay was found to lower the occurrence of bleeding and thrombotic events.

INTERNAL AND EMERGENCY MEDICINE (2022)

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Article Medicine, General & Internal

Effect of P2Y12 Inhibitors on Survival Free of Organ Support Among Non-Critically Ill Hospitalized Patients With COVID-19 A Randomized Clinical Trial

Jeffrey S. Berger et al.

Summary: Adding a P2Y12 inhibitor to anticoagulant therapy did not result in improved organ support-free days in non-critically ill COVID-19 patients hospitalized for COVID-19.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2022)

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Article Medicine, General & Internal

Rivaroxaban versus no anticoagulation for post-discharge thromboprophylaxis after hospitalisation for COVID-19 (MICHELLE): an open-label, multicentre, randomised, controlled trial

Eduardo Ramacciotti et al.

Summary: This study investigated the efficacy of rivaroxaban thromboprophylaxis for 35 days in patients discharged after hospitalisation due to COVID-19. The results showed that this treatment significantly reduced the incidence of venous thromboembolism, with no major bleeding events reported.

LANCET (2022)

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Article Medicine, General & Internal

Aspirin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Peter W. Horby et al.

Summary: In patients hospitalized with COVID-19, aspirin was not associated with reductions in 28-day mortality or in the risk of progressing to invasive mechanical ventilation or death, but was associated with a small increase in the rate of being discharged alive within 28 days.

LANCET (2022)

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Article Hematology

Intermediate-Dose versus Standard-Dose Prophylactic Anticoagulation in Patients with COVID-19 Admitted to the Intensive Care Unit: 90-Day Results from the INSPIRATION Randomized Trial

Behnood Bikdeli et al.

Summary: A study showed that intermediate-dose compared with standard-dose prophylactic anticoagulation did not reduce the risk of death, treatment with ECMO, or venous or arterial thrombosis in critically ill patients with COVID-19 at 90-day follow-up.

THROMBOSIS AND HAEMOSTASIS (2022)

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Article Endocrinology & Metabolism

A prospective study of the impact of glycaemic status on clinical outcomes and anti-SARS-CoV-2 antibody responses among patients with predominantly non-severe COVID-19

David Tak Wai Lui et al.

Summary: This study aimed to evaluate the influence of glycaemic status on clinical outcomes and neutralising antibody responses in COVID-19 patients. The results showed that patients with worse glycaemic status were more likely to experience clinical deterioration, but neutralising antibody responses did not differ across glycaemic status.

DIABETES RESEARCH AND CLINICAL PRACTICE (2022)

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Article Medicine, General & Internal

Effect of Antiplatelet Therapy on Survival and Organ Support-Free Days in Critically Ill Patients With COVID-19 A Randomized Clinical Trial

Charlotte A. Bradbury et al.

Summary: The study results showed that among critically ill patients with COVID-19, treatment with an antiplatelet agent compared with no antiplatelet agent did not significantly improve the number of organ support-free days within 21 days. The use of antiplatelet therapy in critically ill patients with COVID-19 did not show significant benefits.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2022)

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Article Medicine, General & Internal

Low molecular weight heparin is useful in adult COVID-19 inpatients. Experience during the first Spanish wave: observational study

Jose Ramon Gonzalez-Porras et al.

Summary: This observational study showed that the use of low-molecular-weight heparin (LMWH) at the time of admission was associated with lower mortality among adult COVID-19 patients. The intermediate-dose subgroup may have benefited the most. Randomized controlled trials are needed to assess the benefits of heparin within different therapeutic regimes for COVID-19 patients.

SAO PAULO MEDICAL JOURNAL (2022)

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Article Hematology

The association between anticoagulation and adverse outcomes after a positive SARS-CoV-2 test among older outpatients: A population-based cohort study

Husam Abdel-Qadir et al.

Summary: For outpatients aged > 65 years, oral anticoagulation at the time of a positive SARS-CoV-2 test was associated with a lower risk of a composite of death or hospitalization within 60 days.

THROMBOSIS RESEARCH (2022)

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Article Hematology

Good practice statements for antithrombotic therapy in the management of COVID-19: Guidance from the SSC of the ISTH

Alex C. Spyropoulos et al.

Summary: Despite the availability of high-quality trial data, there are still questions about the optimal patient selection, use of antithrombotics in different clinical settings, thromboprophylaxis in special patient populations, and management of acute thrombosis in hospitalized COVID-19 patients. The International Society on Thrombosis and Haemostasis (ISTH) formed a panel to develop recommendations on the use of anticoagulants and antiplatelet agents for COVID-19 patients. The panel agreed on 17 Good Practice Statements (GPS) to guide antithrombotic management in various clinical settings.

JOURNAL OF THROMBOSIS AND HAEMOSTASIS (2022)

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Article Hematology

Association of anticoagulation dose and survival in hospitalized COVID-19 patients: A retrospective propensity score-weighted analysis

Filip Ionescu et al.

Summary: The study found that higher doses of anticoagulants were associated with lower mortality in hospitalized COVID-19 patients. Both therapeutic and prophylactic doses of anticoagulants were shown to reduce the risk of death, but patients receiving therapeutic anticoagulants were more prone to major bleeding.

EUROPEAN JOURNAL OF HAEMATOLOGY (2021)

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Article Hematology

Intermediate-dose anticoagulation, aspirin, and in-hospital mortality in COVID-19: A propensity score-matched analysis

Matthew L. Meizlish et al.

Summary: In this study of hospitalized COVID-19 patients, intermediate-dose anticoagulation and aspirin treatment were each associated with a significantly lower cumulative incidence of in-hospital death as shown by propensity score matching and multivariable regression analysis.

AMERICAN JOURNAL OF HEMATOLOGY (2021)

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Article Cardiac & Cardiovascular Systems

Low-molecular-weight heparin use in coronavirus disease 2019 is associated with curtailed viral persistence: a retrospective multicentre observational study

David Pereyra et al.

Summary: The study found that the use of low molecular weight heparin (LMWH) was associated with improved survival in COVID-19 patients, but did not reduce the increase in thromboinflammation. Instead, it reduced cell death and viral persistence, suggesting potential beneficial effects of LMWH beyond hemostasis in COVID-19 patients without contraindications.

CARDIOVASCULAR RESEARCH (2021)

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Article Medicine, General & Internal

Direct oral anticoagulant use and risk of severe COVID-19

B. Flam et al.

Summary: The study found that ongoing DOAC use was not associated with reducing the risk of severe COVID-19, suggesting that early outpatient DOAC initiation would not modify prognosis.

JOURNAL OF INTERNAL MEDICINE (2021)

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Article Hematology

Prevalence and Predictors of Venous Thromboembolism or Mortality in Hospitalized COVID-19 Patients

Stuart L. Cohen et al.

Summary: This study aimed to identify the prevalence and predictors of venous thromboembolism (VTE) or mortality in hospitalized COVID-19 patients. The overall in-hospital VTE rate was 2.9% (4.9% in the ICU) and a VTE or mortality rate of 26.1%. Key predictors of VTE or mortality included advanced age, increasing CCI, history of cardiovascular disease, ICU level of care, and elevated maximum D-dimer with a cutoff at least four times the ULN. Use of prophylactic-dose anticoagulation but not treatment-dose anticoagulation was associated with reduced VTE or mortality.

THROMBOSIS AND HAEMOSTASIS (2021)

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Article Hematology

Heparin in COVID-19 Patients Is Associated with Reduced In-Hospital Mortality: the Multicenter Italian CORIST Study *

Augusto Di Castelnuovo et al.

Summary: This study evaluated the impact of heparin administration on survival in a large cohort of Italian COVID-19 patients and found that in-hospital heparin treatment was associated with a lower mortality rate, especially in severely ill patients and those with strong coagulation activation. Further results from randomized clinical trials are needed to provide clear recommendations.

THROMBOSIS AND HAEMOSTASIS (2021)

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Article Medicine, General & Internal

Effect of Antithrombotic Therapy on Clinical Outcomes in Outpatients With Clinically Stable Symptomatic COVID-19 The ACTIV-4B Randomized Clinical Trial

Jean M. Connors et al.

Summary: This study aimed to assess the impact of anticoagulant or antiplatelet therapy on symptomatic clinically stable outpatients with COVID-19. The results showed that treatment with aspirin or apixaban compared with placebo did not reduce the rate of a composite clinical outcome, and the study was terminated early due to a lower than anticipated event rate.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2021)

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Article Oncology

Association between warfarin and COVID-19-related outcomes compared with direct oral anticoagulants: population-based cohort study

Angel Y. S. Wong et al.

Summary: This study found a lower risk of COVID-19-related outcomes in patients with non-valvular atrial fibrillation who were using warfarin compared to direct oral anticoagulants (DOACs). Additionally, the study also observed a lower risk of negative control outcomes associated with warfarin.

JOURNAL OF HEMATOLOGY & ONCOLOGY (2021)

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Article Multidisciplinary Sciences

Association of mortality and aspirin prescription for COVID-19 patients at the Veterans Health Administration

Thomas F. Osborne et al.

Summary: The study found that pre-diagnosis aspirin prescription was significantly associated with decreased mortality rates for COVID-19 positive Veterans, indicating the potential benefits of aspirin for patients with COVID-19.

PLOS ONE (2021)

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Article Hematology

Sulodexide in the Treatment of Patients with Early Stages of COVID-19: A Randomized Controlled Trial

Alejandro J. Gonzalez-Ochoa et al.

Summary: Treatment of COVID-19 patients with sulodexide within 3 days of clinical onset improved clinical outcomes, reducing hospitalization and oxygen requirement, lowering D-dimer and CRP levels, with no increased risk of thromboembolic events, major bleeding, or mortality.

THROMBOSIS AND HAEMOSTASIS (2021)

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Article Medicine, General & Internal

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

Alex C. Spyropoulos et al.

Summary: Therapeutic-dose low-molecular-weight heparin reduces major thromboembolism and death in high-risk inpatients with COVID-19, with no significant effect observed in critically ill patients.

JAMA INTERNAL MEDICINE (2021)

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Article Medicine, General & Internal

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

Parham Sadeghipour et al.

Summary: This study compared the effect of intermediate-dose and standard prophylactic anticoagulation on a composite outcome among COVID-19 patients admitted to the ICU. The results showed no significant difference between the two groups in terms of thrombotic events, ECMO therapy, or mortality within 30 days. The study does not recommend routine use of intermediate-dose prophylactic anticoagulation in unselected ICU patients with COVID-19.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2021)

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Article Hematology

Postdischarge thromboembolic outcomes and mortality of hospitalized patients with COVID-19: the CORE-19 registry

Dimitrios Giannis et al.

Summary: Thromboembolic events and mortality from subclinical thrombotic events frequently occur in COVID-19 inpatients. Postdischarge VTE, ATE, and ACM are common, with advanced age and cardiovascular risk factors increasing the risk. Postdischarge anticoagulation can significantly reduce the risk by 46%.

BLOOD (2021)

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Article Hematology

Standard prophylactic versus intermediate dose enoxaparin in adults with severe COVID-19: A multi-center, open-label, randomized controlled trial

Usha S. Perepu et al.

Summary: In hospitalized adults with severe COVID-19, standard prophylactic dose and intermediate dose enoxaparin did not significantly differ in preventing death or thrombosis at 30 days. The occurrence of arterial or venous thrombosis was slightly higher than the rate of major bleeding.

JOURNAL OF THROMBOSIS AND HAEMOSTASIS (2021)

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Article Medicine, General & Internal

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

Renato D. Lopes et al.

Summary: In hospitalized COVID-19 patients with elevated D-dimer concentration, in-hospital therapeutic anticoagulation with rivaroxaban or enoxaparin followed by rivaroxaban to day 30 did not improve clinical outcomes and increased bleeding compared with prophylactic anticoagulation. Therapeutic-dose rivaroxaban and other direct oral anticoagulants should be avoided in these patients without an evidence-based indication for oral anticoagulation.

LANCET (2021)

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Article Medicine, General & Internal

Therapeutic Anticoagulation with Heparin in Noncritically Ill Patients with Covid-19

Patrick R. Lawler et al.

Summary: This study showed that therapeutic-dose anticoagulation with heparin in non-critically ill patients with Covid-19 increased the likelihood of survival to hospital discharge and reduced the need for cardiovascular or respiratory organ support compared to usual-care thromboprophylaxis.

NEW ENGLAND JOURNAL OF MEDICINE (2021)

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Article Medicine, General & Internal

Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19

Ewan C. Goligher et al.

Summary: In critically ill patients with Covid-19, initial therapeutic-dose anticoagulation did not result in improved survival rates or fewer days requiring cardiovascular or respiratory organ support compared to usual-care pharmacologic thromboprophylaxis.

NEW ENGLAND JOURNAL OF MEDICINE (2021)

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Review Clinical Neurology

2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association

Dawn O. Kleindorfer et al.

Summary: Additional digital content is available in the text.

STROKE (2021)

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Article Hematology

Direct-acting oral anticoagulants use prior to COVID-19 diagnosis and associations with 30-day clinical outcomes

Jose Miguel Rivera-Caravaca et al.

Summary: This study compared clinical outcomes between COVID-19 patients on chronic DOAC therapy and those not on oral anticoagulation therapy at the time of diagnosis, showing that the former had higher relative risks and lower 30-day event-free survival compared to the latter.

THROMBOSIS RESEARCH (2021)

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Article Hematology

Randomized trials of therapeutic heparin for COVID-19: A meta-analysis

Michelle Sholzberg et al.

Summary: Therapeutic heparin is beneficial in moderately ill patients with COVID-19, but not in severely ill patients.

RESEARCH AND PRACTICE IN THROMBOSIS AND HAEMOSTASIS (2021)

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Article Medicine, General & Internal

Outpatient and inpatient anticoagulation therapy and the risk for hospital admission and death among COVID-19 patients

Sameh M. Hozayen et al.

Summary: Anticoagulation therapy may be associated with the risk of hospitalization and mortality in COVID-19 patients. Outpatients on anticoagulation therapy at the time of diagnosis experienced a reduced risk of hospitalization, but it did not affect mortality. Inpatients who were not on anticoagulation had an increased risk of mortality.

ECLINICALMEDICINE (2021)

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Article Hematology