Three separate studies adding to the body of evidence around the management and treatment of patients with COVID-19 were the focus of a special hot line session Aug. 29 during ESC Congress 2022 in Barcelona.

In the COVID-PACT trial, which assessed thrombotic events in 750 critically ill patients with COVID-19 requiring ICU-level care, a strategy of full-dose anticoagulation (FDAC) reduced thrombotic complications compared with a standard-dose prophylactic anticoagulation strategy (SDPAC). However, in presenting the findings, David D. Berg, MD, MPH, FACC, noted increased bleeding was observed, driven primarily by transfusions in hemodynamically stable patients. Additionally, the addition of clopidogrel did not reduce thrombotic complications or increase bleeding in this population.

According to Berg, these findings should help inform updates to current guidelines, which suggest using SDPAC over FDAC in critically ill patients. "Weighing thrombotic and bleeding risk, FDAC should be considered to prevent thrombotic complications in selected critically ill patients with COVID-19," he said.

In findings from the ACT Outpatient trial, John Eikelboom, MBBS MSc, said colchicine and aspirin appear to provide no benefits in preventing disease progression or death across the spectrum of disease severity in outpatients with COVID-19. The study, which assessed 3,917 patients from the Middle East, Eurasia, North America, South Asia and South America, found the primary outcome of hospitalization or death occurred in 66 patients in the colchicine group vs. 65 in the control group (HR 1.02; p=0.93). In those patients assigned to the aspirin-only group, major thrombosis, hospitalization or death occurred in 59 patients assigned to aspirin, compared with 73 in the control group (HR 0.80; p=0.21).

"Severity of COVID-19 appears to be diminishing, but the world still needs additional inexpensive, widely-applicable treatments for COVID-19, Eikelboom said.

Meanwhile, in the ACT Inpatient trial assessing the benefits of colchicine and intensified anticoagulant therapy in patients hospitalized with COVID-19, Sanjit Jolly MD, MSc, said colchicine appeared to provide no benefit. However, intensified anticoagulation did reduce thrombosis but not mortality. Researchers also noted that thrombotic events appeared to be less common in inpatients than originally reported. The study included 2,500 inpatients who were randomly assigned (1+1+1+1) to one of four groups: 1) colchicine/rivaroxaban/ASA; 2) colchicine/control; 3) control/rivaroxaban/ASA; 4) Control/Control.

In other COVID-19-related study results, the APOLLO trial presented Aug. 28 found apixaban (2.5 mg/twice daily) compared with placebo did not improve the number of days alive and out of the hospital in symptomatic but clinically stable outpatients with COVID-19 plus additional risk factors for thrombotic complications. Researchers also noted that no major bleeding was observed.

Clinical Topics: Anticoagulation Management, COVID-19 Hub

Keywords: ESC Congress, ESC22, ACC International, Rivaroxaban, Clopidogrel, COVID-19, Anticoagulants, Aspirin, Thrombosis, Intensive Care Units, Disease Progression, Severity of Illness Index, Hospitalization, Colchicine

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