Comparative Analysis of Prophylactic and Therapeutic Anticoagulation in Hospitalized COVID-19 Patients: A Randomized Clinical Trial

By
Mahir Karakas
Shiva Sophia Nicolay
Dominic Wichmann
Stefan Schmiedel
Marylyn M. Addo
Anna Nosko
Natalie Lund
Apurva Shrivastava
Isabell Pink
Daniel Duerschmied
Nadine Gauchel
Elisabeth Schnoy
Ulrich-Frank Pape
Berthold Bein
Philipp Brasch
Dirk Arnold
Katrin Maevers
Sebastian Rasch
Johanna Erber
Tobias Lahmer
Tanja Zeller
Florian Langer
Ann-Kathrin Ozga
Anna Suling
Antonia Zapf
Dominik Jarczak
Stefan Kluge
September 23, 2026

Jama Network Open

Overview

This study evaluates the efficacy of therapeutic versus prophylactic anticoagulation in hospitalized COVID-19 patients. The findings indicate that therapeutic anticoagulation did not significantly reduce the composite primary endpoint of death and thromboembolic events compared to prophylactic dosing.

Background

Coagulopathy is a significant complication in COVID-19 patients, leading to increased morbidity and mortality due to thrombotic events. Understanding the optimal anticoagulation strategy is crucial, as previous studies have shown inconsistent results regarding the effectiveness of therapeutic versus prophylactic anticoagulation.

Data Highlights

No numerical data was provided in the source material.

Key Findings

Therapeutic-dose anticoagulation did not significantly reduce the primary composite endpoint compared to prophylactic dosing.
The study was conducted as a multicenter, assessor-blinded, parallel-group randomized clinical trial.
Participants were allocated 1:1 to either therapeutic anticoagulation or standard prophylaxis.
The trial protocol was approved by federal authorities and local ethics committees.
Recruitment difficulties led to a total of 140 patients being randomized instead of the initially planned 172.

Clinical Implications

The results indicate that therapeutic anticoagulation may not be warranted for all hospitalized COVID-19 patients.

Conclusion

The HERO-19 trial findings contribute to the discussion regarding anticoagulation strategies in COVID-19 patients.

Comparative Analysis of Prophylactic and Therapeutic Anticoagulation in Hospitalized COVID-19 Patients: A Randomized Clinical Trial