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expert reaction to a study looking at prophylactic anticoagulants as a treatment for hospitalised patients with COVID-19

A study published in The BMJ looks at the use of preventative blood thinning drugs to reduce the risk of death in COVID-19 patients.


Dr Mark Skidmore, Senior Lecturer in Biochemisty, Keele University, said:

“This is in line with what has been observed. Furthermore, the WHO has recently made an official recommendation for the use of thromboprophylaxis dosing of anticoagulants1. Randomized trials are indeed pending but there seems to be strong evidence supporting the use of heparin and associated drugs in COVID-19 patients.

“This is a very strong observational cohort study with high quality, strong data supporting prophylactic heparin therapy on hospital admission.  The analysis started with 141,839 patients and after careful and critical consideration of inclusion/exclusion parameters, just over 4,000 were included in the study. Significant covariates were assessed and taken into consideration making the conclusions strong. Pitfalls still exist, but the authors clearly state what they are and reiterate the importance of randomised trials.

“This finding is consistent with previous reports but with a much larger, stronger dataset from a well-designed study. Several small observational cohort studies already indicated the benefits of heparin use. Now, this represents a substantial work once it included thousands of patients. Implications are clear for revising clinical practice on hospital admission of COVID patients, authors are not over-speculating. Also, in vitro data underpinning these findings have been available since early March 20202.

“The authors have accounted for confounders and these have been discussed within the manuscript- the most important thing to be considered is the fact that the authors clearly state the importance of randomised trials.

“A significant reduction in death rate is something that is highly desirable. Perhaps an important factor to be considered would be the time in hospital, as one of the burdens of COVID-19 is hospital bed occupancy leading to death. If this is the case, the use of heparin would represent a drastic shift in COVID-19 management.

“This study reiterates the importance of control randomised trials. Furthermore, different heparin treatment regimes are available – IV, SC, nebulised. Each of which may be targeting a specific disease status and these need testing. While vaccines are becoming a reality, the emergence of variants of concern where vaccine protection may be drastically reduced, available therapeutics of proven efficacy become even more important. Here, it is important to recall that heparin is already widely used and available, while being a relatively cheap drug with a strong safety track record.”

  2. DOI: 10.1101/2020.02.29.971093 &10.1101/2020.04.28.066761 (now published in Thrombosis and Haemostasis doi: 10.1055/s-0040-1721319)



‘Early initiation of prophylactic anticoagulation for prevention of coronavirus disease 2019 mortality in patients admitted to hospital in the United States: cohort study’ by Rentsch et al was published in The BMJ at 00:01 UK time on Friday 12th February.



All our previous output on this subject can be seen at this weblink:



Declared interests

Dr Mark Skidmore: “Dr Skidmore and colleagues have published a number of studies about the use of heparins (an anticoagulant) for the treatment of Covid-19, and indeed one of their papers is referenced in the current press release you’ve enquired about.”



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