Lessons from COVID-19: Trials, Coagulopathy and Crisis Response

NIH ACTIV Platform Trials

NHLBI adaptive platform trials found full dose heparin benefited moderately ill hospitalized COVID-19 patients but not critically ill ICU patients, found no benefit to prophylactic aspirin or apixaban in non-hospitalized patients, and continue studying post-discharge anticoagulation with apixaban.

Crisis Decision Making in a Health System

A hospital system leader described managing early pandemic uncertainty through consolidation of COVID care into one facility, collaboration across nursing and physician teams, and communication through a command center and a symptom based scoring tool with a 70 percent negative predictive value.

COVID Associated Coagulopathy

A review of COVID coagulopathy described rising D-dimer as a strong marker of disease severity and mortality, venous thromboembolism rates as high as 28 percent despite chemoprophylaxis in ICU patients, and endothelial injury and immunothrombosis rather than direct viral activity as the mechanism.

Open Questions and Adaptive Trials

Panelists discussed whether thrombotic risk varies by COVID variant, why heparin seemed less effective than direct thrombin inhibitors in some patients, and the value of adaptive trial designs, closing with a call to consolidate anticoagulation guidance for clinicians.