Abstract
Clinical, laboratory, and autopsy findings support an association between coronavirus disease-2019 (COVID-19) and thromboembolic disease. Acute COVID-19 infection is characterized by mononuclear cell reactivity and pan-endothelialitis, contributing to a high incidence of thrombosis in large and small blood vessels, both arterial and venous. Observational studies and randomized trials have investigated whether full-dose anticoagulation may improve outcomes compared with prophylactic dose heparin. Although no benefit for therapeutic heparin has been found in patients who are critically ill hospitalized with COVID-19, some studies support a possible role for therapeutic anticoagulation in patients not yet requiring intensive care unit support. We summarize the pathology, rationale, and current evidence for use of anticoagulation in patients with COVID-19 and describe the main design elements of the ongoing FREEDOM COVID-19 Anticoagulation trial, in which 3,600 hospitalized patients with COVID-19 not requiring intensive care unit level of care are being randomized to prophylactic-dose enoxaparin vs therapeutic-dose enoxaparin vs therapeutic-dose apixaban. (FREEDOM COVID-19 Anticoagulation Strategy [FREEDOM COVID]; NCT04512079)
【저자키워드】 COVID-19, clinical trial, anticoagulation, Coagulopathy, 【초록키워드】 pathology, coronavirus, Hospitalized, Trial, thrombosis, intensive care, randomized trial, Strategy, outcome, Autopsy, observational study, Laboratory, Critically ill, COVID-19 infection, clinical, therapeutic, Patient, incidence, Care, association, therapeutic anticoagulation, Evidence, mononuclear cell, prophylactic dose, Support, thromboembolic disease, element, small blood vessels, benefit, venous, IMPROVE, investigated, characterized, hospitalized patient, contributing to, reactivity, being randomized, patients with COVID-19, with COVID-19, 【제목키워드】 review, Week,