A worldwide set of clinical trials coordinated in part by researchers at the University of Pittsburgh has found that giving full dose anti-coagulation treatments, or blood thinners, to moderately ill patients hospitalized for COVID-19 reduced the need for vital organ support, such as ventilation. The researchers say that adopting the cheap, readily available treatment could help reduce the burden on intensive care units.
Coordinated by Stephen Wisniewski, vice provost for budget and analytics, and co-led by Pitt physician-scientist Matthew D. Neal, the Roberta G. Simmons Associate Professor of Surgery, the three clinical trial platforms spanning five continents in more than 300 hospitals tested whether there is a greater benefit of full doses of heparin, a type of blood thinner, to treat moderately ill hospitalized adults with COVID-19 compared to the lower heparin dose typically administered to prevent blood clots in hospitalized patients. Moderately ill patients are those not in intensive care and who did not receive organ support, such as mechanical ventilation, at trial enrollment.
Based on the interim results of more than 1,000 of those moderately ill patients, findings showed that full doses of blood thinners—in addition to being safe—were superior to the doses normally given to prevent blood clots in hospitalized patients.
“Prior to this study, the standard of care for a patient who would come into the hospital with COVID-19 would be to receive a low dose of blood thinner to prevent blood clot formation,” said Neal. “What this study shows is that when we give higher doses of blood thinners to patients who are not already critically ill, it is beneficial and should become standard of care.”
The trial investigators are now working as fast as possible to make the full results of the study available so clinicians can make informed decisions about treating their COVID-19 patients.
“In the midst of the pandemic and surges where we are constantly petrified of meeting a challenge of ICU capacity or running short of resources, an intervention that reduces the need for organ support by even just a single day? Magnify that across the scale of pandemic and the number of patients hospitalized—the impact of this stands to be profound,” said Neal.
The trials also suggest a possible reduction in deaths for these patients, but that trend needs further study. Questions also remain about how to further improve the clinical care of COVID-19 patients, which the trial is also investigating. Because the researchers are using an “adaptive” study protocol, different drugs can be started, stopped or combined during the study, based on emerging data.
The trial results reported today complement the group’s findings announced in December that routine use of full-dose anti-coagulation started in the ICU in critically ill COVID-19 patients was not beneficial and may have been harmful in some patients.