COVIDPACT trial results show patients in the ICU due to COVID-19 infection had significantly fewer thrombotic events when treated with full-dose anticoagulation; but full-dose also triggered an excess of bleeding events. ESCCongress
"What the results tell us is that full-dose anticoagulation in critically ill patients with COVID-19 is highly effective for reducing thrombotic complications," said Berg, a cardiologist and critical care physician at Brigham and Women's Hospital in Boston."We probably need to replace the guidelines," saida professor of vascular surgery at Santa Casa School of Medicine in São Paulo, Brazil.
COVID-PACT ran at 34 US centers from August 2020 to March 2022 but stopped short of its enrollment goal of 750 patients because of waning numbers of patients with COVID-19 admitted to ICUs. In addition to randomly assigning patients within 96 hours of their ICU admission to full-dose anticoagulation or to standard-dose antithrombotic prophylaxis, the study included a second, concurrent randomization to the antiplatelet agent clopidogrel or to no antiplatelet drug.
The trial design allowed clinicians to use either low molecular weight heparin or unfractionated heparin for anticoagulation, and 82% of patients received low molecular weight heparin as their initial treatment. The prespecified design called for an on-treatment analysis because of an anticipated high crossover rate. During the trial, 34% of patients who started on the prophylactic dose switched to full dose, and 17% had the reverse crossover.
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