In hospitalized people with severe COVID-19 pneumonia and coagulopathy, therapeutic  anticoagulation appeared to be effective and safe in preventing thromboembolic events.

This randomized controlled study was carried out to compare the efficacy and safety of therapeutic vs. standard prophylactic anticoagulation in coronavirus-infected people.

In this single-center, open-label study, 250 severe COVID-19 people with coagulopathy were randomized to get either prophylactic anticoagulation (subcutaneous unfractionated heparin 5000 IU twice a day or fondaparinux 2.5mg once daily) or therapeutic anticoagulation (weight-adjusted dose unfractionated heparin or fondaparinux). Anticoagulation was given until hospital discharge or at the doctor’s discretion. Throughout the study, all the participants were given international SARS-CoV-2 guideline-driven therapy.
 

The baseline characteristics were not different between the study groups, except for the D-dimer and C-reactive protein level at admission. During the 30-day follow-up, the therapeutic anticoagulation group depicted increased requirement for non-invasive ventilation /invasive mechanical ventilation, higher advancement to acute respiratory distress syndrome, and raised 30-day all-cause mortality when compared to the prophylactic anticoagulation group.

Regarding the incidence of acute myocardial infarction, venous thromboembolism, arterial thromboembolism and overall bleeding at 30-days, no profound difference was witnessed between both the groups, as shown in Table 1:

Therapeutic anticoagulation was considered effective and safe to prevent thromboembolic events, but not in the need for non-invasive ventilation/invasive mechanical ventilation, progression to acute respiratory distress syndrome and 30-day all-cause mortality in hospitalized people having severe COVID-19 and coagulopathy.