The Present and Future
JACC State-of-the-Art Review
Recent Randomized Trials of Antithrombotic Therapy for Patients With COVID-19: JACC State-of-the-Art Review

https://doi.org/10.1016/j.jacc.2021.02.035Get rights and content
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Highlights

  • Venous and arterial thrombosis are prevalent in patients with COVID-19.

  • Optimal thromboprophylaxis has not been established for patients with this disease.

  • Numerous randomized trials are evaluating antithrombotic regimens for outpatients and inpatients with COVID-19.

  • Ongoing experience has influenced the design, conduct, analysis, and reporting the results of these trials.

Abstract

Endothelial injury and microvascular/macrovascular thrombosis are common pathophysiological features of coronavirus disease-2019 (COVID-19). However, the optimal thromboprophylactic regimens remain unknown across the spectrum of illness severity of COVID-19. A variety of antithrombotic agents, doses, and durations of therapy are being assessed in ongoing randomized controlled trials (RCTs) that focus on outpatients, hospitalized patients in medical wards, and patients critically ill with COVID-19. This paper provides a perspective of the ongoing or completed RCTs related to antithrombotic strategies used in COVID-19, the opportunities and challenges for the clinical trial enterprise, and areas of existing knowledge, as well as data gaps that may motivate the design of future RCTs.

Key Words

COVID-19
anticoagulant
antiplatelet
clinical trial
RCT
thrombosis

Abbreviations and Acronyms

BID
twice daily
CI
confidence interval
COVID-19
coronavirus disease-2019
CrCl
creatinine clearance
DOAC
direct oral anticoagulant
HMGB1
high-mobility group box protein 1
ICU
intensive care unit
LMWH
low-molecular-weight heparin
NET
neutrophil extracellular trap
PaO2/FiO2
partial arterial pressure of oxygen/fraction of inspired oxygen
QD
once daily
RCT
randomized controlled trial
SARS-CoV-2
severe acute respiratory syndrome-coronavirus-2
UFH
unfractionated heparin
VTE
venous thromboembolism
WHO
World Health Organization

Cited by (0)

Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.

Paul F. Bray, MD, served as Guest Associate Editor for this paper. Christie Ballantyne, MD, served as Guest Editor-in-Chief for this paper.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.