NCATS-funded study suggests blood thinners may help sickest COVID-19 patients

Treating coronavirus patients with blood thinners could help boost their prospects for survival, according to preliminary findings of a study funded by the National Institutes of Health that offer another clue about treating the deadly condition.

The results of an analysis of 2,733 patients, published last week in the Journal of the American College of Cardiology, are part of a growing body of information about what has worked and what has not during a desperate few months in which doctors have tried dozens of treatments to save those dying of COVID-19, the disease caused by the novel coronavirus. The study was supported by a grant from the National Center for Advancing Translational Sciences (NCATS).

Valentin Fuster, MD, PhD, a physician in chief at Mount Sinai Hospital in New York City and one of the study’s authors, said in an interview that the observations are based only on a review of medical records and that more rigorous, randomized studies are needed to draw broader conclusions, but that the results are promising.

“My opinion is cautious, but I must tell you I think this is going to help,” Fuster said. “This is the opening of the door for what drugs to use and what questions to answer.”

Since March, when the pandemic hit Europe and the United States, doctors have been reporting mysterious blood clots, which can be gel-like or even semisolid, in a significant subset of coronavirus patients. Autopsies of patients who died of respiratory arrest have shown that some had unusual microclots in their lungs rather than the typical damage expected. And last month, doctors reported in the New England Journal of Medicine on five unusual cases of COVID-19-positive people in their 30s and 40s experiencing large strokes.

The Mount Sinai study focused on hospitalized patients treated at its five branches from March 14 through April 11. Among patients who were not on ventilators, those treated with blood thinners died at similar rates to those who did not get blood thinners. But they lived longer — a median of 21 days compared to 14 days.

For patients on ventilators, the difference was more significant. About 63% of patients who did not receive the medications died, compared with 29% who received the treatment. Again, those treated with blood thinners lived longer than those who didn't (median 12 days vs. 9 days).

Another critical finding of the study is that giving blood thinners to these patients appears to be relatively safe. There was not a significant difference in the most dangerous side effect of anticoagulants — bleeding — in those who were on the drugs vs. those who were not.

As a result of the analysis, Fuster said, the hospital system changed its treatment protocols several days ago to begin giving patients with covid-19 higher doses of blood thinners.

A number of medical societies, including the International Society on Thrombosis and Haemostasis and the American Society of Hematology, have issued guidance recommending use of blood thinners for some COVID-19 patients, but the advice has taken a conservative approach.

Fuster said Mount Sinai was beginning a trial last week that will include 5,000 patients who will be randomized into treatment groups to try to get more definitive information. Many unknowns remain about the blood thinners, including the best dosage and timing and whether patients with COVID-19 who are not sick enough to be hospitalized would benefit from taking the medication.

Read more from the Washington Post: https://www.washingtonpost.com/health/2020/05/07/blood-thinners-coronavi...