Farkouh, Michael EStone, Gregg WLala, AnuradhaBagiella, EmiliaMoreno, Pedro RNadkarni, Girish NBen-Yehuda, OriGranada, Juan FDressler, OvidiuTinuoye, Elizabeth OGranada, CarlosBustamante, JessicaPeyra, CarlosGodoy, Lucas CPalacios, Igor FFuster, Valentin2023-03-232023-03-232022-03-08J Am Coll Cardiol. 2022 Mar 8;79(9):917-928http://hdl.handle.net/20.500.12105/15697Clinical, 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. (FREEDOM COVID-19 Anticoagulation Strategy [FREEDOM COVID]; NCT04512079).engVoRhttp://creativecommons.org/licenses/by-nc-nd/4.0/AnticoagulantsCOVID-19Critical CareEnoxaparinHospitalizationHumansPyrazolesPyridonesThromboembolismThrombosisAttribution-NonCommercial-NoDerivatives 4.0 Internacional3524122679991710.1016/j.jacc.2021.12.0231558-3597Journal of the American College of Cardiologyopen access