2026-04-29T12:23:38Zhttps://repisalud.isciii.es/rest/oai/request

oai:repisalud.isciii.es:20.500.12105/164342024-09-27T08:19:24Zcom_20.500.12105_19604com_20.500.12105_2051col_20.500.12105_19605

00925njm 22002777a 4500 dc Stone, Gregg W author Farkouh, Michael E author Lala, Anuradha author Tinuoye, Elizabeth author Dressler, Ovidiu author Moreno, Pedro R author Palacios, Igor F author Goodman, Shaun G author Esper, Rodrigo B author Abizaid, Alexandre author Varade, Deepak author Betancur, Juan F author Ricalde, Alejandro author Payro, Gerardo author Castellano, José María author Hung, Ivan F N author Nadkarni, Girish N author Giustino, Gennaro author Godoy, Lucas C author Feinman, Jason author Camaj, Anton author Bienstock, Solomon W author Furtado, Remo H M author Granada, Carlos author Bustamante, Jessica author Peyra, Carlos author Contreras, Johanna author Owen, Ruth author Bhatt, Deepak L author Pocock, Stuart J author Fuster, Valentin author 2023-05-09 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). J Am Coll Cardiol. 2023 May 9;81(18):1747-1762. 10.1016/j.jacc.2023.02.041 1558-3597 Journal of the American College of Cardiology 36889611 http://hdl.handle.net/20.500.12105/16434 Randomized Trial of Anticoagulation Strategies for Noncritically Ill Patients Hospitalized With COVID-19.