Prophylactic Or Intermediate Dose Heparin in High Risk COVID-19 Patients), ACTION (AntiCoagulaTIon cOroNavirus), and INSPIRATION (Intermediate-dose vs Standard Prophylactic Anticoagulation and Statin vs Placebo in ICU Patients With COVID-19) trials. 1-3 The results of the FREEDOM COVID trial provide some answers about the role of therapeutic anticoagulation in patients with COVID-19, which has been investigated in several trials such as the RAPID COVID COAG (Coagulopathy of COVID-19: A Pragmatic Randomized Controlled Trial of Therapeutic Anticoagulation Versus Standard Care), HEP-COVID (Full Dose Heparin Vs. 7,8 Yet, the associated mortality rate remains in the range of 25-50%. Significant progress has been made on the treatment of COVID-19, including the development of effective primary immunization. In general, patients in India were younger, had fewer comorbidities, and were less likely to have ARDS than patients from other countries. In India, the primary endpoint occurred in 0.7% of patients compared with 21.5% of patients in other countries in the same arm (17.5% in the United States). There were striking differences in event rates per country. The 30-day mortality rate was higher in patients with acute respiratory distress syndrome (ARDS), which was reduced with therapeutic anticoagulation (12.3% vs. Older patients (≥53 years of age) had higher rates of the 30-day primary outcome and were more likely to benefit from therapeutic anticoagulation (primary outcome 19.6% vs. Subgroup analyses were performed in prespecified subgroups. The rate of major bleeding was overall low and similar between groups. 6.4% p = 0.03), but no differences in the rate of pulmonary embolism, deep vein thrombosis, or other systemic thrombosis than in the therapeutic anticoagulation group. 4.9% p = 0.01), as well as a higher need for mechanical ventilation (8.4% vs. There were more deaths in the prophylactic anticoagulation group (7% vs. The primary endpoint developed in 13.2% of patients receiving prophylactic anticoagulation and in 11.3% of patients receiving therapeutic anticoagulation (either enoxaparin or apixaban) (hazard ratio, 0.85 95% confidence interval, 0.69-1.04 p = 0.11). A total of 3,452 patients were randomized at 76 centers in 10 countries, and the study was terminated early because of slow recruitment. 6 The primary effectiveness endpoint was a 30-day composite of all-cause mortality, intensive care unit admission, or systemic thromboembolism. The FREEDOM COVID (FREEDOM COVID-19 Anticoagulation Strategy) trial randomized patients with COVID-19 who were not critically ill into three open-label intervention arms: prophylactic enoxaparin, therapeutic enoxaparin, and apixaban. 1-3 Among different mechanisms, an intrinsic COVID-19 vasculopathy is postulated as a driver of the severe respiratory manifestations of the infection, 4,5 and the role of therapeutic anticoagulation as a treatment target remains an area of interest. 1,2 Despite the development of different therapeutic interventions, including highly effective vaccines, the mortality rate associated with COVID-19 pneumonia is in the range of 25-50%. Respiratory failure is the leading cause of mortality associated with coronavirus disease 2019 (COVID-19) infection. Patients receiving therapeutic anticoagulation had significantly lower mechanical ventilation and mortality rates, with subgroup analyses showing better outcomes in older patients and in those with severe respiratory disease.The FREEDOM COVID (FREEDOM COVID-19 Anticoagulation Strategy) trial randomized patients with COVID-19 who were not critically ill into three intervention arms in a 1:1:1 fashion to study the comparative effectiveness of therapeutic versus prophylactic anticoagulation regimens in reducing the 30-day composite of all-cause mortality, intensive care unit admission, and systemic thrombosis.Anticoagulation is a potentially effective treatment strategy in patients with coronavirus disease 2019 (COVID-19) infection, given evidence of significant pulmonary vasculopathy in patients with respiratory illness.
0 Comments
Leave a Reply. |