Feature | Coronavirus (COVID-19) | July 15, 2021

Study Supports Early Anticoagulant Treatment to Reduce Death in Moderately Ill COVID-19 Patients

International RAPID Trial could contribute to clinical practice

New trial results from the international RAPID Trial show that administering a full dose of a standard blood thinner early to moderately ill hospitalized patients with COVID-19 could halt the thrombo-inflammation process and reduce the risk of severe disease and death. How to anticoagulate COVID patients. How to prevent thrombus in COVID patients.

New trial results from the international RAPID Trial show that administering a full dose of a standard blood thinner early to moderately ill hospitalized patients with COVID-19 could halt the thrombo-inflammation process and reduce the risk of severe disease and death. Getty Images
 


July 15, 2021 — COVID-19 is marked by heightened inflammation and abnormal clotting in the blood vessels, particularly in the lungs, and is believed to contribute to progression to severe disease and death. More than 80 studies are looking at the best way to anticoagulant patients to prevent thrombus formation. New trial results from the international RAPID Trial show that administering a full dose of a standard blood thinner early to moderately ill hospitalized patients with COVID-19 could halt the thrombo-inflammation process and reduce the risk of severe disease and death. 

Heparin, a blood thinner given regularly at low dose to hospitalized patients, stops clots from forming and reduces inflammation. 

The study, led by investigators at St. Michael’s Hospital, a site of Unity Health Toronto, and the University of Vermont Larner College of Medicine, is available as a preprint on MedRxiv.

“This study was designed to detect a difference in the primary outcome that included ICU transfer, mechanical ventilation or death,” said Mary Cushman, M.D., M.Sc., study co-principal investigator and a professor of medicine at the University of Vermont’s Larner College of Medicine.

RAPID Trial Details Inteigating COVID Patients Anticoagulation

The open-label randomized international multi-center clinical RAPID Trial (also known as the RAPID COVID COAG – RAPID Trial) examined the benefits of administering a therapeutic full dose of heparin versus a prophylactic low dose to moderately ill patients admitted to hospital wards with COVID-19. 

The primary outcome was a composite of ICU admission, mechanical ventilation, or death up to 28 days. Safety outcomes included major bleeding. Primary outcome occurred in 37 of 228 patients (16.2%) with therapeutic full dose heparin, and 52 of 237 (21.9%) with low dose heparin (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.43-1.10; p=0.12). Four patients (1.8%) with therapeutic heparin died vs. 18 (7.6%) with prophylactic heparin (OR, 0.22; 95% CI, 0.07-0.65).

“While we found that therapeutic heparin didn't statistically significantly lower incidence of the primary composite of death, mechanical ventilation or ICU admission compared with low dose heparin, the odds of all-cause death were significantly reduced by 78 percent with therapeutic heparin,” explained first author and co-principal investigator Michelle Sholzberg, M.D.C.M., M.Sc., head of division of hematology-oncology, medical director of the coagulation laboratory at St. Michael’s Hospital of Unity Health Toronto, and assistant professor at the University of Toronto. 

Peter Jüni, M.D., co-principal investigator, director of the Applied Health Research Centre (AHRC) at St. Michael’s, and professor of medicine at the University of Toronto, said that the researchers also presented a meta-analysis of randomized evidence (including data from a large multiplatform trial of ATTACC, ACTIV-4a and REMAP-CAP), which clearly indicated that therapeutic heparin is beneficial in moderately ill hospitalized COVID-19 patients. He adds that an additional meta-analysis presented in the preprint showed that therapeutic heparin is beneficial in moderately ill hospitalized patients but not in severely ill ICU patients. 

Another unique aspect of the RAPID Trial was its funding mechanism – a sort of grassroots effort in which support was gathered via Defence Research Development Canada, St. Michael’s Hospital Foundation, St. Joseph’s Healthcare Foundation, participating institutional grants, and even a GoFundMe campaign, among other sources.

“We called this trial ‘The Little Engine that Could,’ because of the sheer will of investigators around the world to conduct it,” said Cushman.
 

 

Related COVID Related Cardiology Content:

Overview of Trials for Anticoagulation Therapy for COVID-19 Patients

 

VIDEO: Antithrombotic Prophylaxis in COVID-19 Patients — Interview with Behnood Bikdeli M.D.

COVID-19 Changes Properties Blood Cells

The Long-term Cardiovascular Impact of COVID-19

COVID-19 Changes Properties Blood Cells

 

Prophylaxis Against Venous Thromboembolism in ICU Patients With COVID-19 Using Enoxaparin

COVID-19 Blood Vessel Damage May Cause Brain Fog and Other Long-hauler Symptoms

Coronavirus Disease 2019 (COVID-19) and the Heart—Is Heart Failure the Next Chapter?

PHOTO GALLERY: How COVID-19 Appears on Medical Imaging

Heart Damage Found in More Than Half of COVID-19 Patients Discharged From Hospitals

 

COVID-19 Can Kill Heart Cells and Interfere With Contraction

Find more COVID cardiology related news and video

 

 

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