{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:52:32Z","timestamp":1787500352105,"version":"build-2736575974"},"reference-count":42,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2023,6,1]]},"abstract":"\n Importance<\/jats:title>\n Given the high risk of thrombosis and anticoagulation-related bleeding in patients with hypoxemic COVID-19 pneumonia, identifying the lowest effective dose of anticoagulation therapy for these patients is imperative.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To determine whether therapeutic anticoagulation (TA) or high-dose prophylactic anticoagulation (HD-PA) decreases mortality and\/or disease duration compared with standard-dose prophylactic anticoagulation (SD-PA), and whether TA outperforms HD-PA; and to compare the net clinical outcomes among the 3 strategies.<\/jats:p>\n <\/jats:sec>\n \n Design, Settings, and Participants<\/jats:title>\n The ANTICOVID randomized clinical open-label trial included patients with hypoxemic COVID-19 pneumonia requiring supplemental oxygen and having no initial thrombosis on chest computer tomography with pulmonary angiogram at 23 health centers in France from April 14 to December 13, 2021. Of 339 patients randomized, 334 were included in the primary analysis\u2014114 patients in the SD-PA group, 110 in the HD-PA, and 110 in the TA. At randomization, 90% of the patients were in the intensive care unit. Data analyses were performed from April 13, 2022, to January 3, 2023.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Patients were randomly assigned (1:1:1) to receive either SD-PA, HD-PA, or TA with low-molecular-weight or unfractionated heparin for 14 days.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n A hierarchical criterion of all-cause mortality followed by time to clinical improvement at day 28. Main secondary outcome was net clinical outcome at day 28 (composite of thrombosis, major bleeding, and all-cause death).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among the study population of 334 individuals (mean [SD] age, 58.3 [13.0] years; 226 [67.7%] men and 108 [32.3%] women), use of HD-PA and SD-PA had similar probabilities of favorable outcome (47.3% [95% CI, 39.9% to 54.8%] vs 52.7% [95% CI, 45.2% to 60.1%];\n P<\/jats:italic>\n \u2009=\u2009.48), as did TA compared with SD-PA (50.9% [95% CI, 43.4% to 58.3%] vs 49.1% [95% CI, 41.7% to 56.6%];\n P<\/jats:italic>\n \u2009=\u2009.82) and TA compared with HD-PA (53.5% [95% CI 45.8% to 60.9%] vs 46.5% [95% CI, 39.1% to 54.2%];\n P<\/jats:italic>\n \u2009=\u2009.37). Net clinical outcome was met in 29.8% of patients receiving SD-PA (20.2% thrombosis, 2.6% bleeding, 14.0% death), 16.4% receiving HD-PA (5.5% thrombosis, 3.6% bleeding, 11.8% death), and 20.0% receiving TA (5.5% thrombosis, 3.6% bleeding, 12.7% death). Moreover, HD-PA and TA use significantly reduced thrombosis compared with SD-PA (absolute difference, \u221214.7 [95% CI \u22126.2 to \u221223.2] and \u221214.7 [95% CI \u22126.2 to \u221223.2], respectively). Use of HD-PA significantly reduced net clinical outcome compared with SD-PA (absolute difference, \u221213.5; 95% CI \u22122.6 to \u221224.3).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n This randomized clinical trial found that compared with SD-PA, neither HD-PA nor TA use improved the primary hierarchical outcome of all-cause mortality or time to clinical improvement in patients with hypoxemic COVID-19 pneumonia; however, HD-PA resulted in significantly better net clinical outcome by decreasing the risk of de novo thrombosis.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT04808882<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamainternmed.2023.0456","type":"journal-article","created":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T05:00:36Z","timestamp":1679461236000},"page":"520","source":"Crossref","is-referenced-by-count":33,"title":["Effects of Standard-Dose Prophylactic, High-Dose Prophylactic, and Therapeutic Anticoagulation in Patients With Hypoxemic COVID-19 Pneumonia"],"prefix":"10.1001","volume":"183","author":[{"given":"Vincent","family":"Labb\u00e9","sequence":"first","affiliation":[{"name":"Service de M\u00e9decine Intensive R\u00e9animation, Centre Hospitalier Universitaire Tenon, Assistance Publique-H\u00f4pitaux de Paris, Sorbonne Universit\u00e9, Paris, France"},{"name":"Service des Soins Intensifs, H\u00f4pital Universitaire de Bruxelles, Universit\u00e9 Libre de Bruxelles, Bruxelles, Belgium"},{"name":"Universit\u00e9 Paris Est Cr\u00e9teil, Institut Mondor de Recherche Biom\u00e9dicale, Groupe de Recherche Clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis), Cr\u00e9teil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damien","family":"Contou","sequence":"additional","affiliation":[{"name":"Service de R\u00e9animation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Heming","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Intensive R\u00e9animation, Centre Hospitalier Universitaire Raymond Poincar\u00e9, Assistance Publique-H\u00f4pitaux de Paris, Universit\u00e9 Versailles Saint Quentin\u2212Universit\u00e9 Paris Saclay, Garches, France."},{"name":"Laboratoire d\u2019infection et inflammation, Unit\u00e9 1173, Facult\u00e9 de M\u00e9decine Simone Veil, Institut national de la sant\u00e9 et de la recherche m\u00e9dicale, Universit\u00e9 Versailles Saint Quentin - Universit\u00e9 Paris Saclay, Garches, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Megarbane","sequence":"additional","affiliation":[{"name":"Service de R\u00e9animation M\u00e9dicale et Toxicologique, Centre Hospitalier Universitaire Lariboisi\u00e8re, Assistance Publique-H\u00f4pitaux de Paris, Universit\u00e9 Paris Cit\u00e9, Paris, France"},{"name":"Unit\u00e9 Mixte de Recherche en Sant\u00e9 1144, Institut national de la sant\u00e9 et de la recherche m\u00e9dicale, Universit\u00e9 Paris Cit\u00e9, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keyvan","family":"Razazi","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Est Cr\u00e9teil, Institut Mondor de Recherche Biom\u00e9dicale, Groupe de Recherche Clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis), Cr\u00e9teil, France"},{"name":"Service de M\u00e9decine Intensive R\u00e9animation, H\u00f4pitaux Universitaires Henri Mondor, Assistance Publique-H\u00f4pitaux de Paris, Universit\u00e9 Paris Est Cr\u00e9teil, Cr\u00e9teil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Boissier","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Intensive R\u00e9animation, Centre Hospitalier 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