Anticoagulation in Patients With COVID-19: JACC Review Topic of the Week

Michael E Farkouh; Gregg W Stone; Anuradha Lala; Emilia Bagiella; Pedro R Moreno; Girish N Nadkarni; Ori Ben-Yehuda; Juan F Granada; Ovidiu Dressler; Elizabeth O Tinuoye; Carlos Granada; Jessica Bustamante; Carlos Peyra; Lucas C Godoy; Igor F Palacios; Valentin Fuster

doi:10.1016/j.jacc.2021.12.023

Anticoagulation in Patients With COVID-19: JACC Review Topic of the Week

J Am Coll Cardiol. 2022 Mar 8;79(9):917-928. doi: 10.1016/j.jacc.2021.12.023.

Authors

Michael E Farkouh¹, Gregg W Stone², Anuradha Lala³, Emilia Bagiella⁴, Pedro R Moreno⁵, Girish N Nadkarni⁶, Ori Ben-Yehuda⁷, Juan F Granada⁷, Ovidiu Dressler⁸, Elizabeth O Tinuoye⁵, Carlos Granada⁹, Jessica Bustamante⁵, Carlos Peyra⁵, Lucas C Godoy¹⁰, Igor F Palacios¹¹, Valentin Fuster¹²

Affiliations

¹ Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
² The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Cardiovascular Research Foundation, New York, New York, USA.
³ The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁴ Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁵ The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁶ The Hasso Plattner Institute for Digital Health at Mount Sinai, New York, New York, USA.
⁷ The Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA.
⁸ The Cardiovascular Research Foundation, New York, New York, USA.
⁹ Cogent Technologies Corporation, Mahwah, New Jersey, USA.
¹⁰ Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada.
¹¹ Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
¹² The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain. Electronic address: [email protected].

Abstract

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).

Keywords: COVID-19; anticoagulation; clinical trial; coagulopathy.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Anticoagulants / therapeutic use*
COVID-19 / complications*
COVID-19 / therapy
Critical Care
Enoxaparin / therapeutic use
Hospitalization
Humans
Pyrazoles / therapeutic use
Pyridones / therapeutic use
Thromboembolism / prevention & control*
Thromboembolism / virology
Thrombosis / prevention & control*
Thrombosis / virology

Substances

Anticoagulants
Enoxaparin
Pyrazoles
Pyridones
apixaban

Associated data

ClinicalTrials.gov/NCT04512079

Abstract

Publication types

MeSH terms

Substances

Associated data

Grants and funding