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Treatment-dose LMWH versus prophylactic/intermediate dose heparins in high risk COVID-19 inpatients: Rationale and design of the HEP-COVID Trial.

Authors:
Mark Goldin Dimitrios Giannis Wassim Diab Janice Wang Sameer Khanijo Gulru Sharifova Marc Cohen Jeet M Lund Andrea Mignatti Eugenia Gianos Alfonso Tafur Paul A Lewis Kevin Cohoon John M Kittelson Martin Lesser Cristina P Sison Husneara Rahman Kanta Ochani William Hiatt Rita A Dale Victoria E Anderson Marc Bonaca Jonathan L Halperin Jeffrey I Weitz Alex Spyropoulos

Thromb Haemost 2021 Apr 6. Epub 2021 Apr 6.

Northwell Health, Feinstein Institutes for Medical Research, Manhasset, United States.

Coronavirus disease-2019 (COVID-19) has been associated with significant risk of venous thromboembolism (VTE), arterial thromboembolism (ATE), and mortality particularly among hospitalized patients with critical illness and elevated D-dimer (Dd) levels. Conflicting data have yet to elucidate optimal thromboprophylaxis dosing. HEP-COVID (NCT04401293) is a Phase 3, multicenter, pragmatic, prospective, randomized, pseudo-blinded, active control trial to evaluate efficacy and safety of therapeutic-dose low molecular weight heparin (LMWH) versus prophylactic-/intermediate-dose LMWH or unfractionated heparin (UFH) for prevention of a primary efficacy composite outcome of VTE, ATE, and all-cause mortality (ACM) 30 ± 2 days post-enrollment. Eligible patients have COVID-19 diagnosis by nasal swab or serologic testing, requirement for supplemental oxygen per investigator judgment, and Dd >4x upper limit of normal (ULN) or sepsis-induced coagulopathy (SIC) score ≥4. Subjects are randomized to enoxaparin 1 mg/kg SQ/BID (CrCl ≥ 30 ml/min) or 0.5 mg/kg (CrCl 15-30 ml/min) vs local institutional prophylactic regimens including: a) UFH up to 22,500 IU daily (divided BID or TID), b) enoxaparin 30mg and 40mg SQ QD or BID, or c) dalteparin 2500IU or 5000 IU QD. The principal safety outcome is major bleeding. Events are adjudicated locally. Based on expected 40% relative risk reduction (RRR) with treatment-dose compared with prophylactic-dose prophylaxis, 308 subjects will be enrolled (assuming 20% drop-out) to achieve 80% power. Distinguishing design features include an enriched population for the composite endpoint anchored on Dd >4x ULN, stratification by ICU vs non-ICU, and the ability to capture asymptomatic proximal deep venous thrombosis via screening ultrasonography prior to discharge.

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http://dx.doi.org/10.1055/a-1475-2351DOI Listing
April 2021

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Treatment-dose LMWH versus prophylactic/intermediate dose heparins in high risk COVID-19 inpatients: Rationale and design of the HEP-COVID Trial.

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Mark Goldin Dimitrios Giannis Wassim Diab Janice Wang Sameer Khanijo Gulru Sharifova Marc Cohen Jeet M Lund Andrea Mignatti Eugenia Gianos Alfonso Tafur Paul A Lewis Kevin Cohoon John M Kittelson Martin Lesser Cristina P Sison Husneara Rahman Kanta Ochani William Hiatt Rita A Dale Victoria E Anderson Marc Bonaca Jonathan L Halperin Jeffrey I Weitz Alex Spyropoulos

Thromb Haemost 2021 Apr 6. Epub 2021 Apr 6.

Northwell Health, Feinstein Institutes for Medical Research, Manhasset, United States.

Coronavirus disease-2019 (COVID-19) has been associated with significant risk of venous thromboembolism (VTE), arterial thromboembolism (ATE), and mortality particularly among hospitalized patients with critical illness and elevated D-dimer (Dd) levels. Conflicting data have yet to elucidate optimal thromboprophylaxis dosing. HEP-COVID (NCT04401293) is a Phase 3, multicenter, pragmatic, prospective, randomized, pseudo-blinded, active control trial to evaluate efficacy and safety of therapeutic-dose low molecular weight heparin (LMWH) versus prophylactic-/intermediate-dose LMWH or unfractionated heparin (UFH) for prevention of a primary efficacy composite outcome of VTE, ATE, and all-cause mortality (ACM) 30 ± 2 days post-enrollment. Read More

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Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia.

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