{"id":20692,"date":"2021-11-14T04:39:00","date_gmt":"2021-11-13T20:39:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=20692"},"modified":"2021-11-15T05:32:03","modified_gmt":"2021-11-14T21:32:03","slug":"icu-management-practice-rapid%e8%af%95%e9%aa%8c%ef%bc%9a%e6%b2%bb%e7%96%97%e6%80%a7%e4%b8%8e%e9%a2%84%e9%98%b2%e6%80%a7%e8%82%9d%e7%b4%a0%e7%94%a8%e4%ba%8e%e6%96%b0%e5%86%a0%e8%82%ba%e7%82%8e","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=20692","title":{"rendered":"[ICU Management & Practice]: RAPID\u8bd5\u9a8c\uff1a\u6cbb\u7597\u6027\u4e0e\u9884\u9632\u6027\u809d\u7d20\u7528\u4e8e\u65b0\u51a0\u80ba\u708e\u60a3\u8005"},"content":{"rendered":"\n

RAPID Trial: Therapeutic Heparin vs Prophylactic Heparin in COVID-19 Patients<\/h1>\n\n\n\n
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A study was conducted to evaluate the effects of therapeutic heparin compared with prophylactic heparin among moderately ill patients with COVID-19 admitted to the hospital.<\/p>\n\n\n\n

Heparin has anticoagulant properties, anti-inflammatory effects and potential antiviral effects and may also improve endothelial function. Early initiation of therapeutic heparin can decrease the thrombo-inflammatory process and reduce the risk of critical illness or death.<\/p>\n\n\n\n

The Therapeutic Anticoagulation versus Standard Care as a Rapid Response to the COVID-19 Pandemic (RAPID) trial aimed to evaluate if therapeutic heparin is superior to prophylactic heparin in moderately ill patients with COVID-19 and increased D-dimer levels admitted to hospital wards and whether it can decrease the composite of admission to an ICU, mechanical ventilation, or death.<\/p>\n\n\n\n

Four hundred sixty-five patients with COVID-19 and admitted to hospital wards were included in the study. Twenty-eight hospitals in Brazil, Canada, Ireland, Saudi Arabia, UAE and the U.S. participated. All patients had increased D-dimer levels and were randomly assigned to therapeutic dose heparin or prophylactic heparin. The dose was continued until hospital discharge, day 28, or death.<\/p>\n\n\n\n

The primary outcome of the study was a composite of death, invasive mechanical ventilation, non-invasive mechanical ventilation, or admission to an ICU, assessed for up to 28 days. Secondary outcomes included all-cause death, the composite of all-cause death or any mechanical ventilation and venous thromboembolism. Safety outcomes included major bleeding.<\/p>\n\n\n\n

Study findings show that at 28 days, the primary composite outcome occurred in 16.2% of patients assigned to therapeutic heparin and 21.9% assigned to prophylactic heparin. Deaths occurred in 1.8% of patients assigned to therapeutic heparin and in 7.6% of patients assigned to prophylactic heparin. The composite of all-cause death or any mechanical ventilation occurred in 10.1% in the therapeutic heparin group and 16% in the prophylactic heparin group. Venous thromboembolism occurred in 0.9% in the therapeutic heparin group and 2.5% in the prophylactic heparin group. Major bleeding occurred in 0.9% in the therapeutic group and 1.7% in the prophylactic group.<\/p>\n\n\n\n

Overall, findings show that in moderately ill patients with COVID-19 and increased D-dimer levels admitted to hospital wards, the use of therapeutic heparin was not significantly associated with a reduction in the primary outcome. However, the odds of death at 28 days decreased with therapeutic heparin.<\/p>\n\n\n\n

Source: BMJ<\/a><\/p>\n\n\n\n

Image Credit: iStock<\/p>\n\n\n\n

\u00ab\u00ab Respiratory Subphenotypes of COVID-19-Related ARDS<\/a><\/p>\n\n\n\n

Timing of Antibiotic Therapy in the Intensive Care Unit \u00bb\u00bb<\/a><\/p>\n\n\n\n

References:<\/h4>\n\n\n\n

Sholzberg M et al. (2021) Effectiveness of therapeutic heparin versus prophylactic heparin on death, mechanical ventilation, or intensive care unit admission in moderately ill patients with covid-19 admitted to hospital: RAPID randomised clinical trial<\/a>. BMJ, 375.<\/p>\n","protected":false},"excerpt":{"rendered":"

RAPID Trial: Therapeutic Heparin vs Prophylactic Hepari […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[24,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/20692"}],"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=20692"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/20692\/revisions"}],"predecessor-version":[{"id":20693,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/20692\/revisions\/20693"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=20692"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=20692"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=20692"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}