Evidence map›Paper›PMID 38938844›Full record

ArticleJACC. Advances2024

Heparin Dose Intensity and Organ Support-Free Days in Patients Hospitalized for COVID-19.

Lucas C Godoy, Matthew D Neal, Ewan C Goligher, Mary Cushman, Brett L Houston, Charlotte A Bradbury, Zoe K McQuilten, Tobias Tritschler, Susan R Kahn, Lindsay R Berry and 30 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in JACC. Advances, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 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

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

40 authors.

Lucas C GodoyPeter Munk Cardiac Centre at the University Health Network, Toronto, Ontario, Canada.
Matthew D NealUniversity of Pittsburgh Medical Center, Pittsburgh, USA.
Ewan C GoligherUniversity of Toronto, Toronto, Ontario, Canada.
Mary CushmanLarner College of Medicine at the University of Vermont, Burlington, Vermont, USA.
Brett L HoustonUniversity of Manitoba, Winnipeg, Canada.
Charlotte A BradburyUniversity of Bristol, Bristol, United Kingdom.
Zoe K McQuiltenAustralian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
Tobias TritschlerDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Susan R KahnMcGill University Health Centre, Montreal, Québec, Canada.
Lindsay R BerryBerry Consultants, LLC, Austin, Texas, USA.
Elizabeth LorenziBerry Consultants, LLC, Austin, Texas, USA.
Tom JensenBerry Consultants, LLC, Austin, Texas, USA.
Alisa M HigginsAustralian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
Lucy Z KornblithZuckerberg San Francisco General Hospital/University of California, San Francisco, California, USA.
Jeffrey S BergerNew York University Grossman School of Medicine, New York, New York, USA.
Michelle N GongMontefiore Medical Center, Bronx, New York, USA.
Jonathan D PaulUniversity of Chicago, Chicago, USA.
Lana A CastellucciDepartment of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada.
Grégoire Le GalDepartment of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada.
Sylvain A LotherUniversity of Manitoba, Winnipeg, Canada.
Robert S RosensonIcahn School of Medicine at Mount Sinai, New York, New York, USA.
Lennie P G DerdeUniversity Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Anand KumarUniversity of Manitoba, Winnipeg, Canada.
Bryan J McVerryUniversity of Pittsburgh Medical Center, Pittsburgh, USA.
Jose C NicolauUniversity of Toronto, Toronto, Ontario, Canada.
Eric LeiferNational Heart, Lung, and Blood Institute, Bethesda, Maryland, USA.
Jorge EscobedoInstituto Mexicano del Seguro Social, Mexico City, Mexico.
David T HuangUniversity of Pittsburgh Medical Center, Pittsburgh, USA.
Harmony R ReynoldsNew York University Grossman School of Medicine, New York, New York, USA.
Marc CarrierDepartment of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada.
Keri S KimUniversity of Illinois, Chicago, Illinois, USA.
Beverley J HuntKing's College and University Guy & St. Thomas Hospital, London, United Kingdom.
Arthur S SlutskyUniversity of Toronto, Toronto, Ontario, Canada.
Alexis F TurgeonUniversité Laval, Québec City, Québec, Canada.
Steven A WebbAustralian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
Colin J McArthurAustralian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
Michael E FarkouhPeter Munk Cardiac Centre at the University Health Network, Toronto, Ontario, Canada.
Judith S HochmanNew York University Grossman School of Medicine, New York, New York, USA.
Ryan ZarychanskiUniversity of Manitoba, Winnipeg, Canada.
Patrick R LawlerPeter Munk Cardiac Centre at the University Health Network, Toronto, Ontario, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Clinical trials suggest that therapeutic-dose heparin may prevent critical illness and vascular complications due to COVID-19, but knowledge gaps exist regarding the efficacy of therapeutic heparin including its comparative effect relative to intermediate-dose anticoagulation. Objectives: The authors performed 2 complementary secondary analyses of a completed randomized clinical trial: 1) a prespecified per-protocol analysis; and 2) an exploratory dose-based analysis to compare the effect of therapeutic-dose heparin with low- and intermediate-dose heparin. Methods: Patients who received initial anticoagulation dosed consistently with randomization were included. The primary outcome was organ support-free days (OSFDs), a combination of in-hospital death and days free of organ support through day 21. Results: Among 2,860 participants, 1,761 (92.8%) noncritically ill and 857 (89.1%) critically ill patients were treated per-protocol. Among noncritically ill per-protocol patients, the posterior probability that therapeutic-dose heparin improved OSFDs as compared with usual care was 99.3% (median adjusted OR: 1.36; 95% credible interval [CrI]: 1.07-1.74). Therapeutic heparin had a high posterior probability of efficacy relative to both low- (94.6%; adjusted OR: 1.26; 95% CrI: 0.95-1.64) and intermediate- (99.8%; adjusted OR: 1.80; 95% CrI: 1.22-2.62) dose thromboprophylaxis. Among critically ill per-protocol patients, the posterior probability that therapeutic heparin improved outcomes was low. Conclusions: Among noncritically ill patients hospitalized for COVID-19 who were randomized to and initially received therapeutic-dose anticoagulation, heparin, compared with usual care, was associated with improved OSFDs, a combination of in-hospital death and days free of organ support. Therapeutic heparin appeared superior to both low- and intermediate-dose thromboprophylaxis.

Indexed as

anticoagulationclinical trialCOVID-19heparinthrombosis

Identifiers

PMID38938844
PMCPMC11198374

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

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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.