Skip to main content
ISTH 2023 Main banner
Back

    Oral Communication

    COVID

    Risk Factors and Treatment in COVID-19

    OC 05.2 - Impact of heparin on disease state transition in hospitalized, non-critically ill patients with COVID-19; secondary analysis of an international multi-platform RCT

    Saturday, June 24, 2023
    13:15 – 13:30 ET
    Room: 511
    Session Available As: On-Demand
    Background: COVID-19 is associated with progression to ICU-level organ support and death. The ATTACC/ACTIV-4a/REMAP-CAP multi-platform RCT (mpRCT) demonstrated a benefit of therapeutic-dose heparin compared with usual care venous thromboprophylaxis in hospitalized, non-critically ill patients with COVID-19; therapeutic-dose heparin was not beneficial in patients requiring ICU-level organ support at baseline. Whether therapeutic-dose heparin should be continued in patients who transition to require ICU-level organ support is unknown.

    Aims: To examine the impact of therapeutic-dose heparin on disease state transition in non-critically ill patients hospitalized for COVID-19.

    Methods: We included hospitalized, non-critically ill patients with COVID-19 enrolled in the ATTACC and ACTIV-4a platforms. The outcome used 3 irreversible states of COVID-19 disease severity: non-critically ill, ICU-level organ support, and death. We employed a multi-state model to analyze the treatment effect of heparin on transitions between states.

    Results: Of the 2095 patients hospitalized for COVID-19 and enrolled in the ATTACC and ACTIV-4a platforms, we included 1922 non-critically ill patients. Heparin was associated with reduced progression from non-critically ill to ICU-level organ support (hazard ratio [HR] 0.84, 95% confidence interval [CI] 0.68 to 1.02; p=0.08). Therapeutic-dose heparin was not associated with reduced mortality among patients in the non-critically ill state (HR 1.26, CI 0.64 to 2.49; p= 0.50), or in those who had transitioned to require organ support (HR 0.91, CI 0.62 to 1.34; p= 0.64). Patients requiring organ support experienced higher rates of bleeding and thrombotic events compared to those who were not critically ill.

    Conclusion(s): Compared to usual care venous thromboprophylaxis, therapeutic-dose heparin may be associated with reduced progression to ICU-level organ support in hospitalized, non-critically ill patients with COVID-19. Therapeutic-dose heparin did not reduce mortality in patients who were non-critically ill or in those that transitioned to require ICU-level organ support. Patients on ICU-level organ support experienced higher rates of bleeding and thrombosis.

    Learning Objectives:

    • Describe the differential treatment effects of therapeutic-dose heparin in noncritically ill patients with COVID-19 relative to different states of disease severity.
    • Describe how treatment with therapeutic-dose heparin affects progression of disease for noncritically ill patients hospitalized for COVID-19.
    • Describe how treatment with therapeutic-dose heparin affects progression from needing ICU-level organ support to mortality for noncritically ill patients hospitalized for COVID-19.