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Based on a new report released by the National Institutes of Health (NIH), full-dose anticoagulation was found to be more beneficial compared to lower prophylactic doses in reducing the need for vital life-saving measures such as mechanical ventilation in moderately ill, non-ICU. hospitalized patients for Covid-19.
“There seems to be a time window – before he enters an ICU – in which a full-dose antidepressant is beneficial,” said Amesh Adalja, MD, an Infectious Disease physician and Senior Professor at Johns Hopkins University. “This demonstrates the progressive treatment required for COVID-19 based on the severity of the disease. ”
In the early months of the pandemic, it was not uncommon for health care providers to administer immunosuppressive or prophylactic doses of antipsychotics (as opposed to full-dose) upon admission to the hospital. Anticoagulants such as low molecular weight heparin or non-heparin, reduce the risk of forming blood clots, a common and potentially fatal condition that became very apparent in the early months of treating patients. by Covid-19.
High levels of thrombosis or blood clots, caused by inflammation from Covid-19, can lead to heart attacks, strokes, and lung emboli (lung clots). Such clinical findings have therefore led to a number of anticoagulation protocols combined with the need for randomized data regarding the routine administration of high doses of anticoagulation to hospitalized patients with Covid-19.
The NIH report described results from three linked clinical trials (REMAP-CAP, ACTIV-4, and ATTACC) looking at the safety and efficacy of full-dose anticoagulation to treat both moderately ill (non -ICU) adults or adults who is critically ill (ICU) hospitalized with COVID-19, as opposed to a prophylactic or lower-dose commonly used to prevent blood clots in hospitalized patients.
But last month, all 3 tests stopped for recording of the seriously ill a subgroup after data showed that full-dose antidepressant initiated in the ICU was not beneficial and may have been harmful in some patients. One could confirm that safety was likely to be a factor in the decision to suspend enrollment in ICU patients, with consideration of potential harm (caused by excessive swelling).
This was not the case, however, for moderately ill patients, defined as those who did not require an ICU level of care (mechanical ventilation or interventions to raise blood pressure). Indeed, in this subgroup of nearly 1,000 patients (who made up 80% of enrollments in all three trials), it was noted that low doses of heparin with low molecular weight or heparin or -trafer better than lower prophylactic doses for the main point of need for ventilation or other organ supportive interventions 21 days postpartum.
“As suspected, # Covid-19 seems to have a sweet spot for antidepressants. Severely ill – there seems to be no benefit in any, moderately ill symptoms. If only we had random people back in March … ”Dr Laura Westafer, emergency medicine physician and director of allied research at the University of Massachusetts Baystate, said in a tweet earlier today.
It is important to understand that, with large numbers of patients currently requiring hospitalization over the coming months, findings from these studies may help to reduce the likelihood of recurrence. -into ICU, with more aggressive treatment earlier in the course of hospitalization. Needless to say, with a shortage of not only ICU beds but trained staff, these decisions may help streamline and improve care in resource-limited areas across the U.S. .
Beyond this, it also clarifies the important role of timing and dose of contraindication in the course of Covid-19. Based on these findings, the take home message is that starting a full-dose anticoagulation is essential and effective earlier in the course of the disease. Patients who were severely ill in the ICU at the time of enrollment did not benefit from full-dose anticoagulation, meaning that it would have been beneficial to begin treatment much earlier in the course of the disease.
And if earlier treatment leads to better outcomes, the question that arises is whether starting antidepressants in Covid-19 patients who do not require hospitalization may also be beneficial. The ACTIV-4B trial currently enrols patients with Covid-19 who do not require hospitalization, randomizing them to the direct oral anticoagulant, apixiban, aspirin, or placebo. This is an important test that could offer a new treatment for the outpatient management of patients with Covid-19 that is safe for discharge, which could prevent the progression of needed illness. to go to the hospital.