The fourth dose of the Covid vaccine “punctures”: 40% of those over 60 have not received them
He anticoagulant treatment at high doses can reduce the mortality rate 30 percent and the need for intubation in 25 percent of patients hospitalized for Covid-19 who are not in critical condition, according to the results of the international study FREEDOM, led by the director-general of the National Center for Cardiovascular Research (CNIC). became. President of Mount Sinai Heart and Chief Physician of Mount Sinai Hospital in New York (USA), Valentine Fuster.
This is the first study to show that high-dose anticoagulation can improve survival in this patient population, a important insight as deaths from Covid-19 remain widespread around the world, particularly in less developed countries.
“We have learned that many patients who have been hospitalized for Covid-19 with lung involvement but have not been admitted to the Intensive Care Unit (ICU) will benefit from one subcutaneous enoxaparin therapy at high doses or atOrally [medicamentos anticoagulantes] to inhibit thrombosis and disease progression,” said Dr. Fuster.
At the start of the pandemic, Fuster noted that many hospitalized patients with Covid-19 were developing high levels of Covid-19 life-threatening blood clots.
Their research showed that prophylactic (low-dose) anticoagulant treatment was associated with better outcomes in patients hospitalized for Covid-19, both in and out of the ICU. The researchers also observed that the therapeutic anticoagulation (at high doses) might give better results.
That’s why they designed this randomized study to find out the most effective regime and dose to improve outcomes for non-critically hospitalized Covid-19 patients.
Between August 26, 2020 and September 19, 2022, they recruited 3,398 adult patients hospitalized with Covid-19 confirmed (mean age 53 years) from 76 hospitals in 10 countries including Spain.
The patients They were not admitted to the intensive care unit or intubatedand about half showed signs of Covid-19 affecting and causing their lungs acute lung failure (ACUTE LUNG FAILURE).
Participants were randomized to receive doses of three different types of anticoagulants in the next 24-48 hours upon admission to the hospital and were 30 days followed.
An equal number of patients were treated with each of the three drug regimens: prophylactic subcutaneous enoxaparin, therapeutic subcutaneous enoxaparin, and therapeutic oral apixaban. The combined therapeutic groups were compared to the prophylactic group.
The CPrimary Endpointor it was a combination of death, requiring intensive care unit care, systemic thromboembolism, or ischemic stroke at 30 days.
Although this criterion was not significantly reduced between the groups, 30-day mortality was lower in patients treated with therapeutic anticoagulation (high dose) than those treated with the prophylactic regimen (low dose).
Thus, 7% of the patients treated with prophylactic anticoagulation died within 30 days compared to 4.9% in the other group, for an overall reduction of 30%.
Regarding the need for intubations, also decreased in the therapeutic group: 6.4 percent of patients were intubated within 30 days compared to 8.4 percent in the prophylaxis group, a 25 percent reduction.
The study showed that therapeutic anticoagulation was particularly beneficial for the patients ARDS patients. Among patients with ARDS at hospital admission, 12.3 percent in the prophylactic anticoagulation group died within 30 days, compared with 7.9 percent in the therapeutic anticoagulation group.
All groups presented low bleeding rates and there were no differences between the two therapeutic anticoagulants in terms of safety and efficacy.
“The information is important for the treatment of patients with Covid-19 who are sick enough to be hospitalized but not sick enough to require intensive care treatment prevents disease progression, particularly the need for intubation, and saves lives. This is especially relevant as Covid-19 is not going away. In the US, the current number of daily deaths, while much lower than at the peak of the pandemic, is double what it was a year ago. And in other countries, Covid-19 is wreaking havoc,” detailed Gregg W. Stone, co-principal investigator of the study.
The results were presented during the American College of Cardiology Scientific Sessions, held in conjunction with the World Congress of Cardiology in New Orleans, United States, and simultaneously published in the scientific journal The Journal of the American College of Cardiology.