Full-dose anticoagulation reduces thrombotic complications in critically ill patients with COVID-19, according to a study published in Circulation. David A. Morrow, MD, and colleagues examined the safety and efficacy of prophylactic, full-dose anticoagulation and antiplatelet therapy in 390 such patients at 34 centers who were randomly assigned to full-dose anticoagulation or standard-dose prophylactic anticoagulation and 292 who were randomly assigned to clopidogrel or no antiplatelet therapy. The proportion of wins was greater for fulldose versus standard-dose anticoagulant (12.3% vs 6.4%; win ratio, 1.95). The results were consistent in a time-to-event analysis for the primary efficacy endpoint (hierarchical composite of death due to venous or arterial thrombosis, pulmonary embolism, clinically evident deep venous thrombosis [DVT], type 1 MI, ischemic stroke, systemic embolic event or acute limb ischemia, or clinically silent DVT, through hospital discharge or 28 days; 9.9% vs 15.2%; HR, 0.56). The primary safety endpoint of fatal or life-threatening bleeding occurred in 2.1% and 0.5% of patients on full-dose and standard-dose anticoagulation, respectively.
