A collaborative international clinical trial testing full-dose anticoagulation with the blood thinner heparin in hospitalized patients with COVID-19 has found the treatment improves survival and reduces the need for vital organ support in moderately ill patients. But the same treatment strategy doesn’t yield the same outcome for critically ill patients.
The formal, final conclusions come from two studies published August 4, 2021 in The New England Journal of Medicine, which garnered much attention in the winter when interim results were announced.
Partly funded by NHLBI, the trial data analysis involved 1,074 critically ill and 2,219 moderately ill patients. Physician investigators gauged how long participants were free of organ support up to 21 days after enrolling in the clinical trial. The investigators discovered that in moderately ill patients full-dose heparin reduced the need for organ support compared to those who received lower-dose heparin. By contrast, for critically ill patients, full-dose heparin was associated with a high probability of a worse outcome.
"These results make for a compelling example of how important it is to stratify patients with different disease severity in clinical trials. What might help one subgroup of patients might be of no benefit, or even harmful, in another," said NHLBI Director Gary H. Gibbons, M.D.