Spyropoulos AC, Goldin M, Giannis D, et al. - In high-risk inpatients with COVID-19, reduction in a composite outcome of major thromboembolism and death was shown to be conferred by thromboprophylaxis with therapeutic-dose low-molecular-weight heparin (LMWH).

• In this multicenter randomized clinical trial (HEP-COVID), 253 hospitalized adult patients with COVID-19 with D-dimer levels more than 4 times the upper limit of normal or sepsis-induced coagulopathy score of 4 or greater were included.

• Participants were randomized to institutional standard prophylactic or intermediate-dose LMWH or unfractionated heparin vs therapeutic-dose enoxaparin, 1 mg/kg subcutaneous, twice daily if creatinine clearance was 30 mL/min/1.73 m ² or greater throughout hospitalization.

• With therapeutic-dose, major thromboembolism or death incidence was 28.7%; in comparison, it was 41.9% with prophylactic/intermediate-dose heparins, a significant difference—driven by decrease in thromboembolism—that was not found in critically ill patients.

• No significant difference in major bleeding was found between groups.