Evidence map›Paper›PMID 34649864›Full record

Trial reportBMJ (Clinical research ed.)2021

Effectiveness of therapeutic heparin versus prophylactic heparin on death, mechanical ventilation, or intensive care unit admission in moderately ill patients with covid-19 admitted to hospital: RAPID randomised clinical trial.

Michelle Sholzberg, Grace H Tang, Hassan Rahhal, Musaad AlHamzah, Lisa Baumann Kreuziger, Fionnuala Ní Áinle, Faris Alomran, Khalid Alayed, Mohammed Alsheef, Fahad AlSumait and 31 more

Registry-linked trialAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04362085 (Coagulopathy of COVID-19), which is not on this map. Cited by 216 papers, 28 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
216citing papers in PubMed, 28 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.

NCT04362085 phase3completednot on this map

Coagulopathy of COVID-19: A Pragmatic Randomized Controlled Trial of Therapeutic Anticoagulation Versus Standard Care as a Rapid Response to the COVID-19 Pandemic (RAPID COVID COAG)

TypeinterventionalSponsorUnity Health TorontoRan2020 to 2021Enrolled465ConditionsCOVID-19ArmsTherapeutic Anticoagulation
3 · Its place in the literature

Who cites it

216 citing papers in PubMed, 28 syntheses or guidelines pooled it.

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  20. Prophylactic anticoagulation with low molecular weight heparin in COVID-19: cohort studies in Denmark and Sweden.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2022
    Pooled it

156 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

41 authors.

Michelle SholzbergDepartments of Medicine, and Laboratory Medicine and Pathobiology, St Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada.ORCID 0000-0003-1220-0301
Grace H TangHaematology-Oncology Clinical Research Group, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Hassan RahhalInternal Medicine Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), University of São Paulo, São Paulo, Brazil.
Musaad AlHamzahDepartment of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Lisa Baumann KreuzigerVersiti, Medical College of Wisconsin, Milwaukee, WI, USA.
Fionnuala Ní ÁinleMater Misericordiae University Hospital, Dublin, Ireland.
Faris AlomranDepartment of Vascular Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Khalid AlayedDepartment of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Mohammed AlsheefMedical Specialties Department, King Fahad Medical City, Riyadh, Saudi Arabia.
Fahad AlSumaitMedical Specialties Department, King Fahad Medical City, Riyadh, Saudi Arabia.
Carlos Eduardo PompilioInternal Medicine Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), University of São Paulo, São Paulo, Brazil.
Catherine SperlichCharles-Lemoyne Hospital, CISSS of Montérégie-Centre, University of Sherbrooke, Greenfield Park, QC, Canada.
Sabrena TangriDepartment of Medicine, William Osler Health System, Brampton, ON, Canada.
Terence TangInstitute for Better Health, Trillium Health Partners, Department of Medicine, University of Toronto, ON, Canada.
Peter JaksaSt Joseph's Health Centre, Unity Health Toronto, Department of Medicine, University of Toronto, Toronto, ON, Canada.
Deepa SuryanarayanDepartment of Medicine, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada.
Mozah AlmarshoodiTawam Hospital, SEHA, AlAin, United Arab Emirates.
Lana A CastellucciDepartment of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, ON, Canada.
Paula D JamesDepartment of Medicine, Queen's University, Kingston, ON, Canada.
David LillicrapDepartment of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada.
Marc CarrierDepartment of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, ON, Canada.
Andrew BeckettSt Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Christos ColovosDivision of Acute Care Surgery, Department of Surgery, University of Vermont Medical Center, VT, USA.
Jai JayakarSouthlake Regional Health Centre, University of Toronto, Newmarket, ON, Canada.
Marie-Pier ArsenaultMaisonneuve-Rosemont Hospital, University of Montréal, Montréal, QC, Canada.
Cynthia WuDivision of Haematology, University of Alberta Hospital, University of Alberta, Edmonton, AB, Canada.
Karine DoyonHospital of the Sacred Heart of Montreal, University of Montréal, Montréal, QC, Canada.
E Roseann AndreouMichael Garron Hospital, University of Toronto, Toronto, ON, Canada.
Vera DounaevskaiaDepartment of Medicine, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Eric K TsengSt Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Gloria LimSt Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Michael FralickGeneral Internal Medicine, Sinai Health, University of Toronto, Toronto, ON, Canada.
Saskia MiddeldorpDepartment of Internal Medicine and Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands.
Agnes Y Y LeeVancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada.
Fei ZuoApplied Health Research Centre, St Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada.
Bruno R da CostaApplied Health Research Centre, St Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada.
Kevin E ThorpeApplied Health Research Centre, St Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada.
Elnara Márcia NegriLaboratory of Medical Investigation (LIM-59), Cellular Biology, Department of Pathology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
Mary CushmanDepartments of Medicine and Pathology and Laboratory Medicine, Larner College of Medicine, University of Vermont, University of Vermont Medical Center, Burlington, VT, USA.
Peter JüniApplied Health Research Centre, St Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, ON, Canada.
RAPID trial investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo evaluate the effects of therapeutic heparin compared with prophylactic heparin among moderately ill patients with covid-19 admitted to hospital wards.

designRandomised controlled, adaptive, open label clinical trial.

setting28 hospitals in Brazil, Canada, Ireland, Saudi Arabia, United Arab Emirates, and US.

participants465 adults admitted to hospital wards with covid-19 and increased D-dimer levels were recruited between 29 May 2020 and 12 April 2021 and were randomly assigned to therapeutic dose heparin (n=228) or prophylactic dose heparin (n=237).

interventionsTherapeutic dose or prophylactic dose heparin (low molecular weight or unfractionated heparin), to be continued until hospital discharge, day 28, or death.

main outcome measuresThe primary outcome was a composite of death, invasive mechanical ventilation, non-invasive mechanical ventilation, or admission to an intensive care unit, assessed up to 28 days. The secondary outcomes included all cause death, the composite of all cause death or any mechanical ventilation, and venous thromboembolism. Safety outcomes included major bleeding. Outcomes were blindly adjudicated.

resultsThe mean age of participants was 60 years; 264 (56.8%) were men and the mean body mass index was 30.3 kg/m

conclusionsIn moderately ill patients with covid-19 and increased D-dimer levels admitted to hospital wards, therapeutic heparin was not significantly associated with a reduction in the primary outcome but the odds of death at 28 days was decreased. The risk of major bleeding appeared low in this trial.

trial registrationClinicalTrials.gov NCT04362085.

Indexed as

Respiration, ArtificialAnticoagulantsBiomarkersCOVID-19FemaleHeparinHospitalizationHumansIntensive Care UnitsMaleMiddle AgedSARS-CoV-2Severity of Illness IndexAnticoagulantsBiomarkersHeparin

Identifiers

PMID34649864
PMCPMC8515466

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Registered trials

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.