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

Research output: Contribution to journalReview articlepeer-review

34 Scopus citations


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.

Original languageEnglish
Pages (from-to)917-928
Number of pages12
JournalJournal of the American College of Cardiology
Issue number9
StatePublished - 8 Mar 2022


  • COVID-19
  • anticoagulation
  • clinical trial
  • coagulopathy


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