ACTION Trial 2021: Anticoagulation in Coronavirus

Therapeutic anticoagulation with COVID-19 infection was not found to be effective in the ACTION study.


Design of the Research: 


Patients with COVID-19 infection were randomly assigned to either therapeutic (n = 311) or preventive (n = 304) anticoagulation. Rivaroxaban 20 mg was given to stable patients on a daily basis. Enoxaparin 1 mg/kg twice daily was given to unsteady patients.


The total number of students enrolled is 615.

The follow-up period is 30 days.

The average patient is 57 years old.

38 percent of the population is female.

Diabetes affects 27% of the population.


Criteria for inclusion:


COVID-19 infection in patients under the age of 18

D-dimer levels are high.




The Most Important Findings:


The primary outcome, a hierarchical analysis of mortality, hospitalization, and oxygen usage over the course of 30 days happened in 34.8 percent of the therapeutic anticoagulation group versus 41.3 percent of the prophylactic anticoagulation group (p = nonsignificant).


Secondary effects include:


All-cause mortality was higher in the therapeutic anticoagulation group (11.3%) than in the prophylactic anticoagulation group (7.6%) (p = nonsignificant).


Venous thromboembolism: 3.5 percent in the therapeutic anticoagulation group vs. 5.9% in the prophylactic anticoagulation group (p = nonsignificant).


Major bleeding, according to the International Society on Thrombosis and Hemostasis (ISTH): 8.4 percent of the therapeutic anticoagulation group against 2.3 percent of the prophylactic anticoagulation group (p 0.05).


Therapeutic anticoagulation was not preferable to preventative anticoagulation in individuals admitted with COVID-19 infection and high D-dimer. Rivaroxaban for stable patients and enoxaparin for unstable patients had no effect on clinical outcomes, but they did increase severe bleeding.


In 2021, COVID-19 was a hot issue, and it was fantastic to see cardiologists conducting several of the studies. In the ACTION trial, COVID-19 patients who were hospitalized were randomly assigned to receive preventive or therapeutic anticoagulation. Therapeutic anticoagulation, on the other hand, had no discernible benefit, despite a considerable increase in bleeding. The trial results were extremely beneficial since, in the absence of randomized data, there was a lot of variation in what hospitals were doing with COVID-19 patients at the time.


Find this trial in Lancet


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