Science & Technology

Anticoagulants reduce the need for ventilators in certain patients with COVID-19

For inpatients with moderate illness COVID-19 (New Coronavirus Infection) Full doses of anticoagulants increased the likelihood of discharge without the need for a ventilator. However, this strategy did not produce the same results for patients with COVID-19 who were severely ill and required intensive care level support at enrollment.

These are the results of two new studies published online on August 4, 2021. New England Journal of Medicine.. The study of moderately and severely ill patients incorporated data from three platform trials as part of a global collaboration to identify possible treatments during a pandemic.The trial is COVID-19 intervention and acceleration of vaccine-4 (ACTIV-4a): A multicenter, adaptive, randomized controlled trial of the safety and efficacy of antithrombotic strategies in inpatient adults with COVID-19. Antithrombotic therapy to improve complications of COVID-19 (ATTACC); When Random implantable multifactorial adaptive platform trial for community-acquired pneumonia (REMAP-CAP) therapeutic anticoagulant therapy..

ACTIV-4a, led by NYU Grossman School of Medicine, University of Pittsburgh researchers, and global collaborators, Researchers have observed that patients who die of COVID-19 have blood clots throughout their body., Including those smallest blood vessels. Doctors saw antithrombotic drugs (also known as anticoagulants or anticoagulants) as potential treatments to reduce the risk of coagulation. However, in this area, we did not know whether the full therapeutic dose used to treat blood clots or the low dose commonly used to prevent blood clots was the most effective.

“In the early stages of the pandemic, a significant prevalence of thrombi that caused serious complications was observed in hospitalized COVID-19 patients,” said ACTIV-4a co-principal investigator and moderate illness. Jeffrey S. Berger MD, co-lead author of the patient study in Japan, said. , Associate Professor of Medicine and Surgery, and Director of the Cardiovascular Disease Prevention Center at NYU Langone Health. “It is noteworthy to lead clinical trials demonstrating that early interventions targeting coagulation can improve outcomes and avoid many COVID-19-related complications.”

As part of their research efforts, the lead researchers in the three platform trials synchronized research protocols to study the effects of the anticoagulant heparin at all and low doses in patients admitted with COVID-19. I was allowed to. The researchers grouped patients according to whether COVID-19 was severe or moderate, and the level of D-dimer, a blood protein that may show coagulation.

Moderate patients admitted with COVID-19 are defined as those who did not receive “organ support” including high-dose oxygen therapy, ventilators, life support, blood pressure-increasing drugs, or drugs that alter the contractile force of the heart. it was done. .. Patients admitted with COVID-19 who needed such assistance were defined as severe or severe.

In April 2020, the research team began randomly assigning half of patients admitted with COVID-19 to receive low-dose or full-dose heparin for up to 14 days after enrollment. By December 2020, Oversight Committee Stop enrolling in critically ill patients When interim results show that full-dose anticoagulant therapy does not reduce the need for organ support and can harm severe and critically ill patients. One month later, the monitoring committee also Stopped enrollment in trials for patients with moderate illness When interim results show that all doses of anticoagulants probably provide benefits. The study enrolled 1,098 critically ill patients and 2,219 moderately ill patients, and researchers measured how long patients were not receiving organ support until 21 days after enrollment in both cohorts. Did.

Among patients with moderate illness, the authors of the study found that all doses of heparin increased the chances of survival to discharge and the need for organ support compared to patients who received low doses of heparin. We found that there was a 99% chance of reducing it. However, although rare, a small number of patients experienced major bleeding. In critically ill patients, all doses of heparin also reduced the number of major thrombotic events, but were more likely to survive to discharge or organs than pharmacological thromboprophylaxis with conventional treatments. I didn’t have many days without support. , The author says.

“These results are very exciting and lead to a better understanding of the implications of applying the right treatments at the right time in the course of this difficult disease,” said ACTIV-4a, Research Chairman. Judith S. Hockman, MD, professor of the Harold Snyder family, said. He is a Senior Vice-President of Cardiology and Clinical Sciences at NYU Grossman Medical College and co-author of research on patients with moderate illness. “Our results help clinicians better treat patients with moderately ill COVID-19 using known and readily available medical treatments,” she says.

ACTIV-4a Antithrombotic Inpatients are conducting further research to test the effects of adding antiplatelet drugs to anticoagulants.

“More work needs to be done to continue to improve outcomes in COVID-19 patients,” said Matthew D. Neil, MD, co-lead author of the study and associate professor Roberta G. Simmons of the University of Pittsburgh. The doctor says. Of the co-lead author of the study of patients with moderate illness and patients with severe illness. “Given what we know about the types of blood clots in COVID-19 patients, testing for antiplatelet drugs is a particularly exciting approach.”


“Therapeutic anticoagulant therapy with heparin in non-severe patients with Covid-19” by ATTACC, ACTIV-4a, and REMAP-CAP Investigators, August 4, 2021 New England Journal of Medicine..
DOI: 10.1056 / NEJMoa2105911

“Therapeutic anticoagulant therapy with heparin in critically ill patients with Covid-19” by REMAP-CAP, ACTIV-4a, and ATTACC Investigators, August 4, 2021 New England Journal of Medicine..
DOI: 10.1056 / NEJMoa2103417

The trials are from the National Institutes of Health (USA), the Canadian Institute of Health, the National Institute of Health (UK), the National Council for Health Medical Research (Australia), and the PREPARE and RECOVER Consortium (European Union). The identifiers for the two published studies are: NCT04505774 When NCT04359277..

Anticoagulants reduce the need for ventilators in certain patients with COVID-19 Anticoagulants reduce the need for ventilators in certain patients with COVID-19

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