{"id":20448,"date":"2021-08-07T04:58:00","date_gmt":"2021-08-06T20:58:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=20448"},"modified":"2021-08-07T06:31:54","modified_gmt":"2021-08-06T22:31:54","slug":"nejm%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e6%96%b0%e5%86%a0%e8%82%ba%e7%82%8e%e5%8d%b1%e9%87%8d%e6%82%a3%e8%80%85%e8%82%9d%e7%b4%a0%e6%8a%97%e5%87%9d%e6%b2%bb%e7%96%97","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=20448","title":{"rendered":"[NEJM\u53d1\u8868\u8bba\u6587]\uff1a\u65b0\u51a0\u80ba\u708e\u5371\u91cd\u60a3\u8005\u809d\u7d20\u6297\u51dd\u6cbb\u7597"},"content":{"rendered":"\n

ORIGINAL ARTICLE<\/a><\/p>\n\n\n\n

Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19<\/h1>\n\n\n\n

The REMAP-CAP, ACTIV-4a, and ATTACC Investigators<\/h3>\n\n\n\n

N Engl J Med August 4, 2021
DOI: 10.1056\/NEJMoa2103417<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

BACKGROUND<\/h2>\n\n\n\n

Thrombosis and inflammation may contribute to morbidity and mortality among patients with coronavirus disease 2019 (Covid-19). We hypothesized that therapeutic-dose anticoagulation would improve outcomes in critically ill patients with Covid-19.<\/p>\n\n\n\n

METHODS<\/h2>\n\n\n\n

In an open-label, adaptive, multiplatform, randomized clinical trial, critically ill patients with severe Covid-19 were randomly assigned to a pragmatically defined regimen of either therapeutic-dose anticoagulation with heparin or pharmacologic thromboprophylaxis in accordance with local usual care. The primary outcome was organ support\u2013free days, evaluated on an ordinal scale that combined in-hospital death (assigned a value of \u22121) and the number of days free of cardiovascular or respiratory organ support up to day 21 among patients who survived to hospital discharge.<\/p>\n\n\n\n

RESULTS<\/h2>\n\n\n\n

The trial was stopped when the prespecified criterion for futility was met for therapeutic-dose anticoagulation. Data on the primary outcome were available for 1098 patients (534 assigned to therapeutic-dose anticoagulation and 564 assigned to usual-care thromboprophylaxis). The median value for organ support\u2013free days was 1 (interquartile range, \u22121 to 16) among the patients assigned to therapeutic-dose anticoagulation and was 4 (interquartile range, \u22121 to 16) among the patients assigned to usual-care thromboprophylaxis (adjusted proportional odds ratio, 0.83; 95% credible interval, 0.67 to 1.03; posterior probability of futility [defined as an odds ratio <1.2], 99.9%). The percentage of patients who survived to hospital discharge was similar in the two groups (62.7% and 64.5%, respectively; adjusted odds ratio, 0.84; 95% credible interval, 0.64 to 1.11). Major bleeding occurred in 3.8% of the patients assigned to therapeutic-dose anticoagulation and in 2.3% of those assigned to usual-care pharmacologic thromboprophylaxis.<\/p>\n\n\n\n

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CONCLUSIONS<\/h2>\n\n\n\n

In critically ill patients with Covid-19, an initial strategy of therapeutic-dose anticoagulation with heparin did not result in a greater probability of survival to hospital discharge or a greater number of days free of cardiovascular or respiratory organ support than did usual-care pharmacologic thromboprophylaxis. (REMAP-CAP, ACTIV-4a, and ATTACC ClinicalTrials.gov numbers, NCT02735707. opens in new tab<\/a>, NCT04505774. opens in new tab<\/a>, NCT04359277. opens in new tab<\/a>, and NCT04372589. opens in new tab<\/a>.)<\/p>\n","protected":false},"excerpt":{"rendered":"

ORIGINAL ARTICLE Therapeutic Anticoagulation with Hepar […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/20448"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=20448"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/20448\/revisions"}],"predecessor-version":[{"id":20449,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/20448\/revisions\/20449"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=20448"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=20448"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=20448"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}