COVID-19: Anticoagulation to reduce intubations and deaths

High-dose anticoagulation may reduce deaths by 30% and intubations by 25% in patients hospitalized with COVID-19

In patients “who are not seriously ill”, high-dose anticoagulation thus has serious advantages, compared to the standard treatment, which is low-dose anticoagulation.

The study, the large-scale international “FREEDOM” trial, led by Dr. Valentin Fuster, Chief Medical Officer of Mount Sinai Hospital, is the first to show that high-dose anticoagulation can improve survival in this patient group . Conducted among 3,398 adult patients hospitalized with confirmed COVID-19, aged on average 53 years, made it possible to demonstrate the effectiveness, in certain patients, of high-dose therapeutic anticoagulation, and to then specify the regimen and the dosage. more efficient. Precisely,

• 30-day mortality is lower in patients treated with therapeutic anticoagulation (high dose)

vs those on prophylactic treatment (low dose);

• 7% of patients treated with prophylactic anticoagulation died within 30 days vs. 4.9% of patients treated with therapeutic anticoagulation, i.e. an overall reduction of 30%;
• the need for intubations is also reduced in the therapeutic anticoagulation group: 6.4% of patients on the therapeutic regimen were intubated within 30 days vs. 8.4% in the prophylactic group, i.e. a reduction of 25%;
• therapeutic anticoagulation was particularly beneficial for patients with acute respiratory distress syndrome (ARDS). Among patients with ARDS at admission, 12.3% in the prophylactic anticoagulation group died within 30 days vs 7.9% in the therapeutic anticoagulation group;
• no difference in adverse effects was observed between the 2 groups of patients.

“A major discovery since deaths from COVID-19 are still numerous”.

“What we learned from this trial is that many patients hospitalized with COVID-19 with lung involvement, but not yet transferred to an intensive care unit (ICU), benefit from high-dose subcutaneous enoxaparin or of oral apixaban to inhibit thrombosis and disease progression”write the authors.

Avoid clots: initially, at the start of the pandemic, these doctors had found that many patients hospitalized with COVID-19 were developing blood clots that might be fatal. The Mount Sinai team shows that:

1. treatment by prophylactic low-dose anticoagulation is associated with better outcomes whether or not the patient is in an ICU;
2. high-dose therapeutic anticoagulation leads to better outcomes in non-critically ill hospitalized COVID-19 patients.

“So this is an important study for patients with COVID-19 who are sick enough to require hospitalization but not sick enough to require intensive care management.”.