The co-authors of an editorial say the HEP-COVID study “confirms and builds” on other studies, leading to three important conclusions concerning the efficacy and safety of anticoagulant therapy in hospitalized patients with COVID-19.

“First, the data support that therapeutic anticoagulation with LMWH or unfractionated heparin is associated with improved outcomes in hospitalized patients with COVID-19 who are not critically ill or in the ICU setting, particularly those patients with elevated D-dimer levels,” write Dr. Lana Wahid and Dr. Thomas Ortel with Duke University Medical Center, in Durham, North Carolina.

“Second, the data also indicate that patients who are critically ill and/or in the ICU do not benefit from therapeutic anticoagulation and manifest an increased risk for bleeding compared with patients receiving prophylactic-dose anticoagulation. The beneficial effect of therapeutic anticoagulation is diminished and the risk of hemorrhage is increased in patients with progressively more severe disease, potentially related to hyperinflammation, endothelial disruption, platelet activation, and coagulopathy,” they say.

“Third, none of the studies would support the use of an anticoagulant administered at a dose between prophylactic and therapeutic, whether for ICU or non-ICU patients,” they note.

The Hep-COVID study was supported by the Feinstein Institutes for Medical Research, the Broxmeyer Fellowship in Clinical Thrombosis, and a grant from the National Institute on Aging. Dr. Spyropoulos has received grants from Janssen and personal fees from Bayer, Bristol Myers Squibb, Boehringer Ingelheim, and The ATLAS Group.

Editor’s note: Please refer to our recent article on COVID Management for more tips.