Full-dose blood thinners may harm and not help patients with COVID-19 in ICU

Because COVID-19 is known to increase the chances of dangerous blood clots, blood thinners have quickly become part of the routine care of many hospitalized patients.

But three clinical trials that tested full doses of these drugs on patients with COVID-19 have now stopped employing critically ill patients because the drugs could ultimately do more harm than good.

According to experts from the U.S. National Institutes of Health (NIH), the finding is limited to patients with COVID-19 who are so ill that they need care in an intensive care unit (ICU).

Based on the test findings and following the recommendations of the supervisory boards in charge of patient safety in clinical trials, “all trial sites stopped reporting the most seriously ill hospitalized patients with COVID-19,” the NIH said in a statement released Tuesday.

“Enrollment continues for moderately ill hospitalized patients with COVID-19 in trials,” the NIH added, as the benefits may still outweigh the risks for patients who do not need ICU care.

According to the NIH, the results so far from three studies show that full-dose blood thinners do this. no it appears to reduce the need for organ support in critically ill adult patients with COVID-19 in intensive care.

On the other hand, there could be potential harm: increased bleeding is a complication of using full doses of blood thinners.

One doctor on the front line of the pandemic agreed that anticoagulants in full doses are dangerous.

“Although lower doses of blood thinners may be useful for both the treatment and prevention of blood clots in patients with mild to moderate COVID-19, higher doses may be associated with harm due to an increased risk of bleeding – potentially affecting the gastrointestinal tract, lungs and brain, “said Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City. “Such abnormal bleeding can be fatal if not diagnosed and treated quickly.”

Further analysis of the data will be available as soon as possible, the NIH said.

Three trials are being conducted on four continents. Each compares the use of full doses of blood thinner with the use of lower doses, which are often used to prevent blood clots in hospitalized patients.

These trials began because health care providers noticed that many patients with COVID-19, including those who died from the disease, developed blood clots throughout their bodies, even in the smallest blood vessels. This unusual clotting can cause serious problems such as lung failure, heart attack and stroke, according to the NIH.

“On the recommendation of supervisory boards, patients who do not need ICU care at the time of enrollment will continue to be included in the trial,” the NIH said.

“The question remains whether the use of full doses compared to low-dose blood thinners leads to better outcomes in hospitalized patients with less severe COVID-19 disease. Patients who require dose blood thinners are not included due to another medical indication in these trials, ”the NIH noted.

Dr. Teresa Murray Amato chairs emergency medicine at Long Island Jewish Forest Hills, also in New York City. Responding to the NIH announcement, she said, “As we learn more about the COVID-19 virus, we continue to research medical treatment.”

She stressed that full-dose blood thinners can still play a role in caring for hospitalized patients who do not need ICU.

“The study continues for less critical patients in the hope that we will continue to develop safe and effective treatments,” Amato said.

More information

The US Centers for Disease Control and Prevention has more information on COVID-19.

SOURCES: Robert Glatter, Ph.D. Med., Emergency Physician, Lenox Hill Hospital, New York; Teresa Murray Amato, Ph.D. Med., Chair, Emergency Medicine, Long Island Jewish Forest Hills, New York; U.S. National Institutes of Health, press release, December 22, 2020

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