Should Anticoagulants Be Used Early Or Late In Patients Hospitalized With Covid-19: Two Conflicting Answers

Doctors treating patients with a new disease face uncertainties. Will the treatment benefit or harm the patient or make no measurable difference. The results of controlled clinical trials and the difference between treatment and placebo, provide the guideposts for decisions. What must doctors do when the results of early clinical trials are ambiguous or contradictory as they often are for a new disease such as Covid-19.

Here I describe just such an example. Should patients hospitalized for Covid-19 be treated with anticoagulants as early as possible, or should treatment be delayed until clinical signs indicate that hyper-coagulation is likely? This is just one of the many judgments caregivers must make in facing a new complex disease such as Covid-19.

Hyper-coagulation (excessive blood-clotting) is a cause of death and disability facing patients hospitalized for severe Covid-19. Anticoagulants (blood thinners) have been reported to reduce in-hospital deaths. The question then becomes how early should anticoagulation therapy begin upon hospitalization. Here I review two studies that reach different conclusions.

Originally published on Forbes on February 26, 2021  
© William A. Haseltine, PhD. All Rights Reserved.