Clinical question: Does standard-dose prophylactic anticoagulation (SD-PA), high-dose prophylactic anticoagulation (HD-PA), or therapeutic anticoagulation (TA) have a greater benefit in patients with hypoxemic COVID-19 pneumonia?
Background: Due to the nature of heightened thrombotic risk with COVID-19-related inflammation, platelet activation, and endothelial dysfunction leading to microvascular thrombosis, it is important to determine whether TA or HD-PA decreases mortality and/or disease duration compared to SD-PA.
Study design: Open-label, multicenter, randomized, clinical trial
Setting: 23 health centers in France from April 14 to December 13, 2021
Synopsis: The ANTICOVID trial included 334 individuals. In randomized patients, CT pulmonary angiography was required to be performed during the 72 hours before or up to 24 hours after inclusion. The use of HD-PA and SD-PA had similar probabilities of favorable outcomes, as did TA compared with SD-PA and TA compared with HD-PA. Net clinical outcome was met in 29.8% of patients receiving SD-PA, 16.4% receiving HD-PA, and 20.0% receiving TA. Moreover, HD-PA and TA use significantly reduced thrombosis compared with SD-PA. At day 90 there were no significant differences in composite secondary efficacy and safety outcomes among the three groups, nor in all-cause death and quality of life.
Bottom line: The results of the ANTICOVID trial indicate that neither HD-PA nor TA use improved the primary hierarchical outcomes—death and time to clinical improvement—when compared with SD-PA use among patients with hypoxemic COVID-19 pneumonia. However, HD-PA resulted in significantly better net clinical outcomes by decreasing the risk of de novo thrombosis.
Citation: Labbé V, et al. Effects of standard-dose prophylactic, high-dose prophylactic, and therapeutic anticoagulation in patients with hypoxemic COVID-19 pneumonia: The ANTICOVID randomized clinical trial. JAMA Intern Med. 2023;183(6):520-31.
Dr. Shah
Dr. Shah is co-medical director of hospital medicine at High Point Medical Center in High Point, N.C., a hospitalist at Atrium Health Wake Forest Baptist, and an assistant professor in hospital medicine at Wake Forest University School of Medicine, both in Winston-Salem, N.C.