email article Extended therapeutic-level prophylactic anticoagulation with rivaroxaban (Xarelto) for COVID-19 patients with elevated D-dimer levels wasn't better and carried more bleeding risk than lower hospital-only doses, the ACTION trial showed. Standard prophylactic-level dosing actually "won" on mortality, duration of hospitalization, and duration of oxygen use through 30 days more often compared with the more intensive regimen, reported Renato Lopes, MD, PhD, of the Duke Clinical Research Institute in Durham, North Carolina, at the virtual American College of Cardiology (ACC) meeting. The trial randomized 615 patients to a standard approach of in-hospital prophylactic-dose anticoagulation or to a strategy with rivaroxaban (20 mg daily in hospital) if stable or enoxaparin (1 mg/kg twice daily) if unstable while in the hospital then rivaroxaban continued through day 30 whether still in the hospital or discharged home.