• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
COVID-19 Management

RAPID RCT Results: Prophylactic or Therapeutic Doses of Heparin for Hospitalized Patients with COVID-19?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Sholzberg et al. (BMJ, 2021) compared therapeutic heparin vs prophylactic heparin among moderately ill, hospitalized COVID-19 patients

METHODS:

  • Randomized controlled, adaptive, open label clinical trial
    • 6 countries | 28 hospitals
  • Participants
    • Adults admitted to the hospital with COVID-19 (between May 2020 and April 2021)
    • Moderately ill: Admission to hospital but not ICU | Not already mechanically ventilated | Not imminently requiring mechanical ventilation or critical care
    • Increased D-dimer levels
  • Interventions
    • Therapeutic dose of heparin (dosing used for the treatment of venous thromboembolism)
    • Prophylactic dose heparin (protocols used for the prevention of venous thromboembolism)
    • Note: Heparin refers to either low molecular weight or unfractionated heparin
  • Study design
    • Both groups continued intervention until they were discharged, day 28, or death
    • Outcomes were blindly adjudicated
  • Primary outcome
    • Composite: Death | Invasive mechanical ventilation | Non-invasive mechanical ventilation | ICU admission
    • Assessed up to 28 days
  • Secondary outcomes
    • All cause death
    • A composite of all cause death or any mechanical ventilation
    • Venous thromboembolism
  • Safety outcomes
    • Major bleeding

RESULTS:

  • Therapeutic dose: 228 participants | Prophylactic dose: 237 participants
    • Mean age 60 years
    • 56.8% men
    • Mean BMI 30.3 kg/m2
  • No significant difference in incidence of the primary composite outcome between the two groups
    • Therapeutic: 16.2%
    • Prophylactic: 21.9%
    • Odds ratio 0.69 (95% CI, 0.43 to 1.10); P=0.12
  • Deaths occurred in fewer patients in the therapeutic heparin group
    • Therapeutic: 1.8%
    • Prophylactic: 7.6%
    • OR 0.22 (95% CI, 0.07 to 0.65); P=0.006
  • There was no significant difference in
    • The composite of all cause death or any mechanical ventilation
      • Therapeutic: 10.1%
      • Prophylactic: 16.0%
      • OR 0.59 (95% CI, 0.34 to 1.02); P=0.06
    • Venous thromboembolism
      • Therapeutic: 0.9%
      • Prophylactic: 2.5%
      • OR 0.34 (95% CI, 0.07 to 1.71); P=0.1
  • There was no difference in major bleeding incidents between the two groups
    • Therapeutic: 0.9%
    • Prophylactic: 1.7%
    • OR 0.52 (95% CI, 0.09 to 2.85); P=0.69

CONCLUSION:

  • There was no significant difference in the primary composite outcome among moderately ill COVID-19 patients who received either therapeutic or prophylactic doses of heparin
  • Mortality was significantly decreased in the therapeutic heparin group by 78%
  • There was a low risk of major bleeding in both groups
  • The authors state

…given variation in findings from published trials, prospective meta-analyses will be important to determine the effects of different types and doses of anticoagulants in different patient subgroups

Learn More – Primary Sources:

Effectiveness of therapeutic heparin versus prophylactic heparin on death, mechanical ventilation, or intensive care unit admission in moderately ill patients with covid-19 admitted to hospital: RAPID randomised clinical trial

Get Mobile-Friendly COVID-19 Research Summaries with ObGFirst

ObGFirst® – Try It Free! »

image_pdfFavoriteLoadingFavorite
< Previous
All COVID-19 Management Posts
Next >

Related ObG Topics:

RCT Results: Does Therapeutic Heparin Dose Improve Outcomes in Patients with COVID-19?
RCT Results: Therapeutic or Prophylactic Anticoagulation for Hospitalized COVID-19 Patients?
Does Prophylactic Anticoagulation Reduce Mortality in Hospitalized COVID-19 Patients?

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site