Imperial College London
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Professor Anthony Gordon

Faculty of Medicine, Department of Surgery & Cancer

Chair in Anaesthesia and Critical Care
 
 
 
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Contact

 

anthony.gordon

 
 
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Location

 

ICUQueen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{The:2021:10.1056/nejmoa2105911,
author = {The, ATTACC and ACTIV-4a and and, REMAP-CAP Investigators},
doi = {10.1056/nejmoa2105911},
journal = {New England Journal of Medicine},
pages = {790--802},
title = {Therapeutic anticoagulation with heparin in noncritically Ill patients with Covid-19},
url = {http://dx.doi.org/10.1056/nejmoa2105911},
volume = {385},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BACKGROUNDThrombosis and inflammation may contribute to the risk of death and complications among patients with coronavirus disease 2019 (Covid-19). We hypothesized that therapeutic-dose anticoagulation may improve outcomes in noncritically ill patients who are hospitalized with Covid-19.METHODSIn this open-label, adaptive, multiplatform, controlled trial, we randomly assigned patients who were hospitalized with Covid-19 and who were not critically ill (which was defined as an absence of critical care–level organ support at enrollment) to receive pragmatically defined regimens of either therapeutic-dose anticoagulation with heparin or usual-care pharmacologic thromboprophylaxis. The primary outcome was organ support–free days, evaluated on an ordinal scale that combined in-hospital death (assigned a value of −1) and the number of days free of cardiovascular or respiratory organ support up to day 21 among patients who survived to hospital discharge. This outcome was evaluated with the use of a Bayesian statistical model for all patients and according to the baseline d-dimer level.RESULTSThe trial was stopped when prespecified criteria for the superiority of therapeutic-dose anticoagulation were met. Among 2219 patients in the final analysis, the probability that therapeutic-dose anticoagulation increased organ support–free days as compared with usual-care thromboprophylaxis was 98.6% (adjusted odds ratio, 1.27; 95% credible interval, 1.03 to 1.58). The adjusted absolute between-group difference in survival until hospital discharge without organ support favoring therapeutic-dose anticoagulation was 4.0 percentage points (95% credible interval, 0.5 to 7.2). The final probability of the superiority of therapeutic-dose anticoagulation over usual-care thromboprophylaxis was 97.3% in the high d-dimer cohort, 92.9% in the low d-dimer cohort, and 97.3% in the unknown d-dimer cohort. Major bleeding occurred in 1.9% of the patients receiving therapeutic
AU  - The,ATTACC
AU  - ACTIV-4a
AU  - and,REMAP-CAP Investigators
DO  - 10.1056/nejmoa2105911
EP  - 802
PY  - 2021///
SN  - 0028-4793
SP  - 790
TI  - Therapeutic anticoagulation with heparin in noncritically Ill patients with Covid-19
T2  - New England Journal of Medicine
UR  - http://dx.doi.org/10.1056/nejmoa2105911
UR  - https://www.nejm.org/doi/10.1056/NEJMoa2105911
UR  - http://hdl.handle.net/10044/1/90873
VL  - 385
ER  -
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