Evidence map›Paper›PMID 32977137›Full record

Trial reportThrombosis research2020

Therapeutic versus prophylactic anticoagulation for severe COVID-19: A randomized phase II clinical trial (HESACOVID).

Anna Cristina Bertoldi Lemos, Douglas Alexandre do Espírito Santo, Maísa Cabetti Salvetti, Renato Noffs Gilio, Lucas Barbosa Agra, Antonio Pazin-Filho, Carlos Henrique Miranda

Abstract readClinical Trial, Phase IIComparative StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Thrombosis research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 143 papers, 25 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
143citing papers in PubMed, 25 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

143 citing papers in PubMed, 25 syntheses or guidelines pooled it.

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  9. FullHaematologica · 2022
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  10. Guideline
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  13. Anticoagulants for people hospitalised with COVID-19: a rapid reviewThe Cochrane database of systematic reviews · 2022
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  17. Guideline
  18. Active prescription of low-dose aspirin during or prior to hospitalization and mortality in COVID-19: A systematic review and meta-analysis of adjusted effect estimates.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2021
    Pooled it
  19. Current evidence for COVID-19 therapies: a systematic literature review.European respiratory review : an official journal of the European Respiratory Society · 2021
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83 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

Anna Cristina Bertoldi LemosDivision of Emergency Medicine, Department of Internal Medicine, Ribeirão Preto School of Medicine, São Paulo University, Ribeirão Preto, SP, Brazil.
Douglas Alexandre do Espírito SantoDivision of Emergency Medicine, Department of Internal Medicine, Ribeirão Preto School of Medicine, São Paulo University, Ribeirão Preto, SP, Brazil.
Maísa Cabetti SalvettiHospital Estadual de Américo Brasiliense, Ribeirão Preto School of Medicine, São Paulo University, Ribeirão Preto, SP, Brazil.
Renato Noffs GilioHospital Estadual de Américo Brasiliense, Ribeirão Preto School of Medicine, São Paulo University, Ribeirão Preto, SP, Brazil.
Lucas Barbosa AgraDivision of Emergency Medicine, Department of Internal Medicine, Ribeirão Preto School of Medicine, São Paulo University, Ribeirão Preto, SP, Brazil.
Antonio Pazin-FilhoDivision of Emergency Medicine, Department of Internal Medicine, Ribeirão Preto School of Medicine, São Paulo University, Ribeirão Preto, SP, Brazil.
Carlos Henrique MirandaDivision of Emergency Medicine, Department of Internal Medicine, Ribeirão Preto School of Medicine, São Paulo University, Ribeirão Preto, SP, Brazil. Electronic address: chmiranda@fmrp.usp.br.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionCoronavirus disease 2019 (COVID-19) causes a hypercoagulable state. Several autopsy studies have found microthrombi in pulmonary circulation.

methodsIn this randomized, open-label, phase II study, we randomized COVID-19 patients requiring mechanical ventilation to receive either therapeutic enoxaparin or the standard anticoagulant thromboprophylaxis. We evaluated the gas exchange over time through the ratio of partial pressure of arterial oxygen (PaO2) to the fraction of inspired oxygen (FiO2) at baseline, 7, and 14 days after randomization, the time until successful liberation from mechanical ventilation, and the ventilator-free days.

resultsTen patients were assigned to the therapeutic enoxaparin and ten patients to prophylactic anticoagulation. There was a statistically significant increase in the PaO2/FiO2 ratio over time in the therapeutic group (163 [95% confidence interval - CI 133-193] at baseline, 209 [95% CI 171-247] after 7 days, and 261 [95% CI 230-293] after 14 days), p = 0.0004. In contrast, we did not observe this improvement over time in the prophylactic group (184 [95% CI 146-222] at baseline, 168 [95% CI 142-195] after 7 days, and 195 [95% CI 128-262] after 14 days), p = 0.487. Patients of the therapeutic group had a higher ratio of successful liberation from mechanical ventilation (hazard ratio: 4.0 [95% CI 1.035-15.053]), p = 0.031 and more ventilator-free days (15 days [interquartile range IQR 6-16] versus 0 days [IQR 0-11]), p = 0.028 when compared to the prophylactic group.

conclusionTherapeutic enoxaparin improves gas exchange and decreases the need for mechanical ventilation in severe COVID-19.

trial registrationREBEC RBR-949z6v.

Indexed as

COVID-19 Drug TreatmentAdultAgedAnticoagulantsBrazilCOVID-19Drug Administration ScheduleEnoxaparinFemaleHumansLungMaleMiddle AgedPulmonary Gas ExchangeRespiration, ArtificialThrombophiliaAnticoagulantsEnoxaparinAnticoagulant treatmentCoagulopathyCOVID-19D-dimerMechanical ventilation

Identifiers

PMID32977137
PMCPMC7503069

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.