Fewer new clots using high-dose prophylactic anticoagulation for patients with hypoxemic COVID-19 pneumonia (ANTICOVID)

Clinical Question

What dose of anticoagulation provides the most benefit for patients hospitalized with hypoxemic COVID-19 pneumonia?

Bottom line

In this study of mostly critically ill patients with hypoxemic COVID-19 pneumonia and no evidence of pulmonary embolus, neither high-dose prophylactic anticoagulation nor therapeutic anticoagulation led to a mortality benefit when compared with standard-dose prophylaxis. However, high-dose prophylaxis did provide a net efficacy and safety benefit over standard-dose anticoagulation by reducing de novo thrombosis by four-fold without increasing the rate of major bleeding. Therapeutic anticoagulation did not provide any additional benefit over high-dose prophylaxis. 1b

Study design: Randomized controlled trial (nonblinded)

Funding: Industry

Setting: Inpatient (any location)


Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL

Discuss this POEM



Impact assessment


Duncan Scott Mackey

Reference to usual vs 2x

A resident who was uncertain of the usual dose and any maximums brought this to my attention. Being explicit for a dose of tinzaparin would be helpful for those who are less familiar. Great choice of article - changes what we do.


covid pneumonia

high dose anticoag therapy reduces clots