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(UPDATED) Investigators were “floored by the results,” and can’t understand why the DOAC was linked with higher mortality.

ACTIV-4a study shows ticagrelor or clopidogrel combined with heparin did not prevent clotting in moderately sick COVID patients

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) mee...

May 17, 2021 Therapeutic-dose anticoagulation primarily consisting of rivaroxaban (Xarelto; Bayer/Janssen), compared with standard thromboprophylaxis, does not improve outcomes in patients hospitalized with COVID-19 who have elevated D-dimer levels, according to results from the randomized ACTION trial. A “win ratio” analysis indicated that full-dose anticoagulation was no better, and potentially worse, than usual care in terms of a hierarchical composite endpoint of mortality, duration of hospitalization, and duration of oxygen use through 30 days, Renato Lopes, MD, PhD (Duke Clinical Re...

January 13, 2021 Another randomized trial, REPLACE COVID, indicates that patients already taking ACE inhibitors and ARBs when they’re hospitalized for COVID-19 should continue to do so, supporting recommendations from international CV societies. When it came to outcomes including all-cause death, duration of mechanical ventilation, time on renal replacement or vasopressor therapy, and multiorgan dysfunction during hospitalization, there were no differences between patients who continued versus discontinued their renin-angiotensin-aldosterone-system (RAAS) inhibitors after they were admitted...