A high dose of an inexpensive and globally available blood-thinning medication reduces the risk of death in hospitalized patients who are moderately ill with COVID-19, suggests a new study.

The international RAPID Trial led by St. Michael’s Hospital (Toronto, Canada) compared the effects of a high, therapeutic dose of heparin to a prophylactic low dose for patients with moderate COVID-19 and increased d-dimer levels admitted to hospitals. Heparin is a universally used blood thinner that prevents the formation of blood clots. D-dimers are protein fragments produced when a blood clot gets dissolved in the blood stream - increased d-dimer levels indicate higher risks of blood clots.

The researchers studied 465 patients in hospitals around the world and found that while the therapeutic dose of heparin was not associated with a significant reduction in the study’s primary outcome, a composite of death, the need for mechanical ventilation or admission to intensive care, the dosing of heparin did reduce all-cause death in moderately-ill COVID-19 patients admitted to hospital by 78%.

Therapeutic doses of heparin are used for deep vein thrombosis or pulmonary emboli, whereas prophylactic, or lower, doses are used for patients admitted to Internal Medicine wards to prevent blood clotting while they are in hospital. Several trials have explored the use of blood thinners in COVID-19 patients because the virus causes heightened inflammation and clotting in blood vessels, which contributes to severe disease and death. The researchers hope that this research contributes to a change in treatment guidelines for COVID-19 patients and could make a difference in areas where vaccine availability or coverage continues to be limited.

“Our study confirms therapeutic heparin is beneficial in patients who are on the ward with COVID-19, but other studies suggest it could be harmful for patients who are in critical care,” said Dr. Peter Jüni, Director of the Applied Health Research Centre at St. Michael’s and co-lead of the study.

“This is a once-in-a-million opportunity - heparin is inexpensive, globally available, and exists in every single hospital pharmacy cabinet right now,” added Dr. Michelle Sholzberg, Head of the Division of Hematology-Oncology and Director of the Coagulation Lab at St. Michael’s, and co-lead on the study. “It’s an opportunity to rapidly repurpose a drug available around the world.”

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