Por favor, use este identificador para citar o enlazar este Item:http://hdl.handle.net/20.500.12105/16434
Título
Randomized Trial of Anticoagulation Strategies for Noncritically Ill Patients Hospitalized With COVID-19.
Autor(es)
Stone, Gregg W | Farkouh, Michael E | Lala, Anuradha | Tinuoye, Elizabeth | Dressler, Ovidiu | Moreno, Pedro R | Palacios, Igor F | Goodman, Shaun G | Esper, Rodrigo B | Abizaid, Alexandre | Varade, Deepak | Betancur, Juan F | Ricalde, Alejandro | Payro, Gerardo | Castellano, José María | Hung, Ivan F N | Nadkarni, Girish N | Giustino, Gennaro | Godoy, Lucas C | Feinman, Jason | Camaj, Anton | Bienstock, Solomon W | Furtado, Remo H M | Granada, Carlos | Bustamante, Jessica | Peyra, Carlos | Contreras, Johanna | Owen, Ruth | Bhatt, Deepak L | Pocock, Stuart J | Fuster, Valentin
Fecha de publicación
2023-05-09
Cita
J Am Coll Cardiol. 2023 May 9;81(18):1747-1762.
Idioma
Inglés
Tipo de documento
journal article
Resumen
BACKGROUND
Prior studies of therapeutic-dose anticoagulation in patients with COVID-19 have reported conflicting results.
OBJECTIVES
We sought to determine the safety and effectiveness of therapeutic-dose anticoagulation in noncritically ill patients with COVID-19.
METHODS
Patients hospitalized with COVID-19 not requiring intensive care unit treatment were randomized to prophylactic-dose enoxaparin, therapeutic-dose enoxaparin, or therapeutic-dose apixaban. The primary outcome was the 30-day composite of all-cause mortality, requirement for intensive care unit-level of care, systemic thromboembolism, or ischemic stroke assessed in the combined therapeutic-dose groups compared with the prophylactic-dose group.
RESULTS
Between August 26, 2020, and September 19, 2022, 3,398 noncritically ill patients hospitalized with COVID-19 were randomized to prophylactic-dose enoxaparin (n = 1,141), therapeutic-dose enoxaparin (n = 1,136), or therapeutic-dose apixaban (n = 1,121) at 76 centers in 10 countries. The 30-day primary outcome occurred in 13.2% of patients in the prophylactic-dose group and 11.3% of patients in the combined therapeutic-dose groups (HR: 0.85; 95% CI: 0.69-1.04; P = 0.11). All-cause mortality occurred in 7.0% of patients treated with prophylactic-dose enoxaparin and 4.9% of patients treated with therapeutic-dose anticoagulation (HR: 0.70; 95% CI: 0.52-0.93; P = 0.01), and intubation was required in 8.4% vs 6.4% of patients, respectively (HR: 0.75; 95% CI: 0.58-0.98; P = 0.03). Results were similar in the 2 therapeutic-dose groups, and major bleeding in all 3 groups was infrequent.
CONCLUSIONS
Among noncritically ill patients hospitalized with COVID-19, the 30-day primary composite outcome was not significantly reduced with therapeutic-dose anticoagulation compared with prophylactic-dose anticoagulation. However, fewer patients who were treated with therapeutic-dose anticoagulation required intubation and fewer died (FREEDOM COVID [FREEDOM COVID Anticoagulation Strategy]; NCT04512079).
MESH
Versión en línea
DOI
Aparece en las colecciones
Ficheros en el ítem
- Nombre:
- Randomized Trial of Anticoagul ...
- Tamaño:
- 1.377Mb
- Formato:
- Descripción:
- Artículo