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Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19
- Source :
- New England Journal of Medicine, New England Journal of Medicine, Massachusetts Medical Society, 2021, 385 (9), pp.777-789. ⟨10.1056/NEJMoa2103417⟩, New England journal of medicine, 385(9), 777-789. Massachussetts Medical Society, et al. 2021, ' Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19 ', New England Journal of Medicine, vol. 385, no. 9, pp. 777-789 . https://doi.org/10.1056/NEJMoa2103417, NEW ENGLAND JOURNAL OF MEDICINE, The New England Journal of Medicine, 385, 9, pp. 777-789, Investigators, REMAP-CAP & Dark, P 2021, ' Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19 ', The New England Journal of Medicine, vol. 385, no. 9, pp. 777-789 . https://doi.org/10.1056/NEJMoa2103417, The New England Journal of Medicine, 385, 777-789, The New England journal of medicine
- Publication Year :
- 2021
-
Abstract
- BACKGROUNDThrombosis and inflammation may contribute to morbidity and mortality among patients with coronavirus disease 2019 (Covid-19). We hypothesized that therapeutic-dose anticoagulation would improve outcomes in critically ill patients with Covid-19.METHODSIn an open-label, adaptive, multiplatform, randomized clinical trial, critically ill patients with severe Covid-19 were randomly assigned to a pragmatically defined regimen of either therapeutic-dose anticoagulation with heparin or pharmacologic thromboprophylaxis in accordance with local usual care. The primary outcome was organ support–free days, evaluated on an ordinal scale that combined in-hospital death (assigned a value of −1) and the number of days free of cardiovascular or respiratory organ support up to day 21 among patients who survived to hospital discharge.RESULTSThe trial was stopped when the prespecified criterion for futility was met for therapeutic-dose anticoagulation. Data on the primary outcome were available for 1098 patients (534 assigned to therapeutic-dose anticoagulation and 564 assigned to usual-care thromboprophylaxis). The median value for organ support–free days was 1 (interquartile range, −1 to 16) among the patients assigned to therapeutic-dose anticoagulation and was 4 (interquartile range, −1 to 16) among the patients assigned to usual-care thromboprophylaxis (adjusted proportional odds ratio, 0.83; 95% credible interval, 0.67 to 1.03; posterior probability of futility [defined as an odds ratio CONCLUSIONSIn critically ill patients with Covid-19, an initial strategy of therapeutic-dose anticoagulation with heparin did not result in a greater probability of survival to hospital discharge or a greater number of days free of cardiovascular or respiratory organ support than did usual-care pharmacologic thromboprophylaxis. (REMAP-CAP, ACTIV-4a, and ATTACC ClinicalTrials.gov numbers, NCT02735707. opens in new tab, NCT04505774. opens in new tab, NCT04359277. opens in new tab, and NCT04372589. opens in new tab.)
- Subjects :
- Male
covid-19, anticoagulation
adaptive platform trial
[SDV]Life Sciences [q-bio]
Critical Illness
Vascular damage Radboud Institute for Health Sciences [Radboudumc 16]
lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4]
Hemorrhage
030204 cardiovascular system & hematology
heparin
COVID-19/drug therapy
03 medical and health sciences
0302 clinical medicine
Medicine, General & Internal
Hemorrhage/chemically induced
General & Internal Medicine
Odds Ratio
thrombosis, covid-19
Humans
030212 general & internal medicine
Hospital Mortality
Treatment Failure
Heparin/administration & dosage
anticoagulation
11 Medical and Health Sciences
Aged
Anticoagulants/administration & dosage
Science & Technology
Thrombosis/prevention & control
Heparin
low molecular weight heparin
Anticoagulants
COVID-19
Thrombosis
General Medicine
Middle Aged
Respiration, Artificial
3. Good health
COVID-19 Drug Treatment
critical care
lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4]
Logistic Models
ACTIV-4a Investigators
Female
Human medicine
ATTACC Investigators
REMAP-CAP Investigators
Covid-19
Life Sciences & Biomedicine
Subjects
Details
- ISSN :
- 00284793 and 15334406
- Volume :
- 385
- Database :
- OpenAIRE
- Journal :
- The New England Journal of Medicine
- Accession number :
- edsair.doi.dedup.....85dfa0ff9303f71a226cade0fe2e7521