Enoxaparin for primary thromboprophylaxis in symptomatic outpatients with COVID-19 (OVID): a randomised, open-label, parallel-group, multicentre, phase 3 trial

Voci, Davide; Held, Ulrike; Sebastian, Tim; Bingisser, Roland; Colucci, Giuseppe; Duerschmied, Daniel; Frenk, A.; Gerber, Bernhard; Götschi, Andrea; Konstantinides, Stavros; Mach, François; Robert‐Ebadi, Helia; Rosemann, Thomas; Simon, Noemi R; Spechbach, Hervé; Spirk, David; Stortecky, Stefan; Vaisnora, Lukas; Righini, Marc; Kucher, Nils; Zetzsche, Stéphanie Roth; Spescha, Rebecca; Leeger, Claudia; Butscheid, Yulia; Probst, Eliane; Micieli, Evy; Forgó, Gábor; Johner, Fabian; Grigorean, Alexandru; Vatsakis, Georgios; Lang, Dagmar Keller; Speck, Silvana Rampini; Hasse, Barbara; Rueegg, Marco; Arnold, Isabelle C.; Nickel, Christian H.; Busch, Jeannette; Blondon, Marc; Glauser, Frédéric; Cittone, Micol Giulia; Kessler, Chiara; Gjermeni, Diona; Olivier, Christoph B.; Gauchel, Nadine; Biever, Paul; Hobohm, Lukas; Becker, Dorothea; Schindewolf, Marc; Kuenzi, Arnaud; Ulrich, Silvia

doi:10.1016/s2352-3026(22)00175-2

Cited by 44 publications

(45 citation statements)

References 16 publications

(22 reference statements)

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“…The Enoxaparin for Primary Thromboprophylaxis in Ambulatory Patients With COVID-19 (OVID) trial included patients older than 50 years presenting with acute COVID-19 symptoms. 70 There was no significant reduction in the PE rate between standard-intensity prophylactic anticoagulation with enoxaparin for 14 days and standard of care (RR: 0.25, 95% CI: 0.03–2.26). No bleeding events were reported.…”

Section: Preventionmentioning

confidence: 87%

COVID-19-Associated Pulmonary Embolism: Review of the Pathophysiology, Epidemiology, Prevention, Diagnosis, and Treatment

Ortega‐Paz

Talasaz

Sadeghipour

et al. 2022

Semin Thromb Hemost

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COVID-19 is associated with endothelial activation in the setting of a potent inflammatory reaction and a hypercoagulable state. The end result of this thromboinflammatory state is an excess in thrombotic events, in particular venous thromboembolism. Pulmonary embolism (PE) has been of special interest in patients with COVID-19 given its association with respiratory deterioration, increased risk of intensive care unit admission, and prolonged hospital stay. The pathophysiology and clinical characteristics of COVID-19-associated PE may differ from the conventional non–COVID-19-associated PE. In addition to embolic events from deep vein thrombi, in situ pulmonary thrombosis, particularly in smaller vascular beds, may be relevant in patients with COVID-19. Appropriate prevention of thrombotic events in COVID-19 has therefore become of critical interest. Several changes in viral biology, vaccination, and treatment management during the pandemic may have resulted in changes in incidence trends. This review provides an overview of the pathophysiology, epidemiology, clinical characteristics, and risk factors of COVID-19-associated PE. Furthermore, we briefly summarize the results from randomized controlled trials of preventive antithrombotic therapies in COVID-19, focusing on their findings related to PE. We discuss the acute treatment of COVID-19-associated PE, which is substantially similar to the management of conventional non-COVID-19 PE. Ultimately, we comment on the current knowledge gaps in the evidence and the future directions in the treatment and follow-up of COVID-19-associated PE, including long-term management, and its possible association with long-COVID.

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Section: Preventionmentioning

confidence: 87%

COVID-19-Associated Pulmonary Embolism: Review of the Pathophysiology, Epidemiology, Prevention, Diagnosis, and Treatment

Ortega‐Paz

Talasaz

Sadeghipour

et al. 2022

Semin Thromb Hemost

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Section: Tablementioning

confidence: 99%

“…There is no discussion, instead, that routine primary thromboprophylaxis in symptomatic COVID-19 outpatients would not be clinically effective, and should hence be currently discouraged. 34,35 To close off this discussion, we should also point out the possibility for confusion in regards to the characterization of COVID-19 severity. In particular, the term "COVID-19-associated acute illness," which may alternatively be called "hospitalized non-critically ill," or as used in one Commentary in this issue as "COVID-19-associated moderate illness," 11 has the potential to be confused with "COVID-19associated severe illness" or "COVID-19-associated critical illness."…”

mentioning

confidence: 99%

Strength of Anticoagulation in Moderate to Severe COVID-19 Illness: In Medio Stat Virtus?

Lippi

Favaloro

2022

Semin Thromb Hemost

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“…In the first, Stefano Barco and colleagues for the OVID investigators present data comparing enoxaparin 40 mg daily for 14 days with open control among 472 symptomatic outpatients with COVID-19 in Switzerland and Germany. 6 In a manner almost identical to ACTIV-4B, the OVID DSMB elected to terminate the trial early on the basis of lower than anticipated event rates and a low probability of showing efficacy associated with active intervention; overall, the trial primary endpoint of any hospitalisation or death occurred in eight individuals in the group allocated to enoxaparin and eight in those allocated to open control (hazard ratio [HR] 0·98 95% CI 0·37–2·56; p=0·96). All hospitalisations were due to respiratory insufficiency or COVID-19 pneumonia with no deaths recorded.…”

mentioning

confidence: 99%

Antithrombotic prophylaxis for symptomatic outpatients with COVID-19: less is consistently more

Connors

Ridker

2022

The Lancet Haematology

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Enoxaparin for primary thromboprophylaxis in symptomatic outpatients with COVID-19 (OVID): a randomised, open-label, parallel-group, multicentre, phase 3 trial

Cited by 44 publications

References 16 publications

COVID-19-Associated Pulmonary Embolism: Review of the Pathophysiology, Epidemiology, Prevention, Diagnosis, and Treatment

COVID-19-Associated Pulmonary Embolism: Review of the Pathophysiology, Epidemiology, Prevention, Diagnosis, and Treatment

Strength of Anticoagulation in Moderate to Severe COVID-19 Illness: In Medio Stat Virtus?

Antithrombotic prophylaxis for symptomatic outpatients with COVID-19: less is consistently more

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