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

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 journal › Review article › peer-review

42 Scopus citations

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.

Original language	English
Pages (from-to)	917-928
Number of pages	12
Journal	Journal of the American College of Cardiology
Volume	79
Issue number	9
DOIs	https://doi.org/10.1016/j.jacc.2021.12.023
State	Published - 8 Mar 2022

Keywords

COVID-19
anticoagulation
clinical trial
coagulopathy

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10.1016/j.jacc.2021.12.023

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Farkouh, M. E., Stone, G. W., Lala, A., Bagiella, E., Moreno, P. R., Nadkarni, G. N., Ben-Yehuda, O., Granada, J. F., Dressler, O., Tinuoye, E. O., Granada, C., Bustamante, J., Peyra, C., Godoy, L. C., Palacios, I. F., & Fuster, V. (2022). Anticoagulation in Patients With COVID-19: JACC Review Topic of the Week. Journal of the American College of Cardiology, 79(9), 917-928. https://doi.org/10.1016/j.jacc.2021.12.023

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title = "Anticoagulation in Patients With COVID-19: JACC Review Topic of the Week",

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.",

keywords = "COVID-19, anticoagulation, clinical trial, coagulopathy",

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

note = "Publisher Copyright: {\textcopyright} 2022 The Authors",

year = "2022",

month = mar,

day = "8",

doi = "10.1016/j.jacc.2021.12.023",

language = "English",

volume = "79",

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Farkouh, ME, Stone, GW , Lala, A , Bagiella, E, Moreno, PR, Nadkarni, GN, Ben-Yehuda, O, Granada, JF, Dressler, O, Tinuoye, EO, Granada, C, Bustamante, J, Peyra, C, Godoy, LC, Palacios, IF & Fuster, V 2022, 'Anticoagulation in Patients With COVID-19: JACC Review Topic of the Week', Journal of the American College of Cardiology, vol. 79, no. 9, pp. 917-928. https://doi.org/10.1016/j.jacc.2021.12.023

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T1 - Anticoagulation in Patients With COVID-19

T2 - JACC Review Topic of the Week

AU - Farkouh, Michael E.

AU - Stone, Gregg W.

AU - Lala, Anuradha

AU - Bagiella, Emilia

AU - Moreno, Pedro R.

AU - Nadkarni, Girish N.

AU - Ben-Yehuda, Ori

AU - Granada, Juan F.

AU - Dressler, Ovidiu

AU - Tinuoye, Elizabeth O.

AU - Granada, Carlos

AU - Bustamante, Jessica

AU - Peyra, Carlos

AU - Godoy, Lucas C.

AU - Palacios, Igor F.

AU - Fuster, Valentin

PY - 2022/3/8

Y1 - 2022/3/8

N2 - 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.

AB - 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.

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KW - coagulopathy

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M3 - Review article

C2 - 35241226

AN - SCOPUS:85124732270

SN - 0735-1097

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JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 9

ER -

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

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Keywords

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