Anticoagulation for COVID-19: Seeking clarity and finding yet more gray

At the onset of the SARS-CoV-2 pandemic, a vacuum of direct evidence to guide treatment of the novel COVID-19 disease led to the swift proposal and variable adoption of a litany of potentially beneficial but unproven therapies. Efforts by researchers worldwide subsequently produced persuasive data to support or refute many studied interventions, and clinical practice and guidelines changed rapidly in accordance. Despite these efforts, research did not provide sustained clarity regarding the benefits, or lack thereof, of all proposed COVID-19 interventions.

Anticoagulation for COVID-19 is one such story. Early in the pandemic, there was substantial interest in therapeutic anticoagulation as a protective therapy for COVID-19 based on reports of high rates of hypercoagulability and thrombotic complications. However, clinical trials evaluating various anticoagulation regimens in patients with COVID-19 reported often-conflicting results. As the pandemic progressed and mortality attributed to SARS-CoV-2 declined, clinical practice and society guidelines for hospitalized patients with COVID-19 moved away from earlier recommendations for routine therapeutic anticoagulation, but questions about the optimal role and dosing of anticoagulation in COVID-19 were never definitively answered.

Claire N Shappell, George L Anesi