Evidence map›Paper›PMID 37979717›Full record

Trial reportChest2024

Symptoms and Impaired Quality of Life After COVID-19 Hospitalization: Effect of Therapeutic Heparin in Non-ICU Patients in the Accelerating COVID-19 Therapeutic Interventions and Vaccines 4 Acute Trial: Effect on 3-Month Symptoms and Quality of Life.

Yonatan Y Greenstein, Kinsley Hubel, Joshua Froess, Stephen R Wisniewski, Vidya Venugopal, Yu-Hsuan Lai, Jeff S Berger, Steven Y Chang, Christos Colovos, Faraaz Shah and 18 more

Registry-linked trialOpen access · greenAbstract readRandomized Controlled Trial
In one paragraph

Trial report in Chest, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04505774 (A Multicenter, Adaptive, Randomized Controlled Platform Trial of the Safety and Efficacy of Antithrombotic and Additional Strategies in Hospitalized Adults With COVID-19), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.6field-weighted citation impact, top 28% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04505774 phase4completednot on this map

A Multicenter, Adaptive, Randomized Controlled Platform Trial of the Safety and Efficacy of Antithrombotic and Additional Strategies in Hospitalized Adults With COVID-19

TypeinterventionalSponsorMatthew Neal MDRan2020 to 2024Enrolled3,591ConditionsCovid19Armstheraputic heparin, prophylactic heparin, P2Y12, Crizanlizumab Injection, SGLT2 inhibitor
3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 3 citations in OpenAlex.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

28 authors at 16 institutions in 3 countries.

Yonatan Y GreensteinRutgers New Jersey Medical School, Newark, NJ.
Kinsley HubelOregon Health & Science University, Portland, OR.
Joshua FroessUniversity of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
Stephen R WisniewskiUniversity of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
Vidya VenugopalUniversity of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
Yu-Hsuan LaiUniversity of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
Jeff S BergerNYU Grossman School of Medicine, New York, NY.
Steven Y ChangDavid Geffen School of Medicine at UCLA, Los Angeles, CA.
Christos ColovosUniversity of Vermont Larner College of Medicine, Burlington, VT.
Faraaz ShahUniversity of Pittsburgh School of Medicine, Pittsburgh, PA.
Lucy Z KornblithUCSF School of Medicine, San Francisco, CA.
Patrick R LawlerPeter Munk Cardiac Centre, Toronto General Hospital, Toronto, ON, Canada; McGill University Health Centre, Montreal, QC, Canada.
Manila GaddhEmory University School of Medicine, Atlanta, GA.
Raquel Morillo GuerreroHospital Ramon y Cajal, Madrid, Spain.
William NkemdirimAlbert Einstein College of Medicine, Bronx, NY.
Renato D LopesDuke University School of Medicine, Durham, NC.
Harmony R ReynoldsNYU Grossman School of Medicine, New York, NY.
Jose Seijas AmigoHospital Clinico Santiago, Santiago de Compostela, Spain.
Lana WahidDuke University School of Medicine, Durham, NC.
Ajani ZahraKaiser Permanente, Los Angeles, CA.
Ewan C GoligherUniversity of Toronto, Toronto, ON, Canada.
Ryan ZarychanskiUniversity of Manitoba, Winnipeg, MB, Canada.
Eric LeiferNational Heart, Lung, and Blood Institute, Bethesda, MD.
David T HuangUniversity of Pittsburgh School of Medicine, Pittsburgh, PA.
Matthew D NealUniversity of Pittsburgh School of Medicine, Pittsburgh, PA.
Judith S HochmanNYU Grossman School of Medicine, New York, NY.
Mary CushmanUniversity of Vermont Larner College of Medicine, Burlington, VT.
Michelle N GongAlbert Einstein College of Medicine, Bronx, NY. Electronic address: mgong@montefiore.org.
University of Pittsburgh · USNew York University · USAlbert Einstein College of Medicine · USDuke University · USUniversity of Vermont · USComplejo Hospitalario Universitario de Santiago · ESEmory University · USHospital Universitario Ramón y Cajal · ESKaiser Permanente · USMcGill University Health Centre · CANational Heart Lung and Blood Institute · USOregon Health & Science University · USRutgers, The State University of New Jersey · USUniversity of California, Los Angeles · USUniversity of Manitoba · CAUniversity of Toronto · CA

Funding

ACTIV Integration of Host-targeting Therapies for COVID-19 Administrative Coordinating CenterOT2HL156812 · NHLBI · RESEARCH TRIANGLE INSTITUTE · PI NOLEN, TRACY L, THOMAS, SONIA M · 2020 to 2024
$1270.7M
NHLBI NIH HHS OT2 HL156812NHLBI NIH HHS OTA-20-011
6 · The paper itself

Abstract

backgroundTherapeutic-dose heparin decreased days requiring organ support in noncritically ill patients hospitalized for COVID-19, but its impact on persistent symptoms or quality of life (QOL) is unclear. RESEARCH QUESTION: In the Accelerating COVID-19 Therapeutic Interventions and Vaccines 4 ACUTE (ACTIV-4a) trial, was randomization of patients hospitalized for COVID-19 illness to therapeutic-dose vs prophylactic heparin associated with fewer symptoms and better QOL at 90 days? STUDY DESIGN AND

methodsThis was an open-label randomized controlled trial at 34 hospitals in the United States and Spain. A total of 727 noncritically ill patients hospitalized for COVID-19 from September 2020 to June 2021 were randomized to therapeutic-dose vs prophylactic heparin. Only patients with 90-day data on symptoms and QOL were analyzed. We ascertained symptoms and QOL by the EQ-5D-5L at 90-day follow-up in a preplanned analysis for the ACTIV-4a trial. Individual domains assessed by the EQ-5D-5L included mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Univariate and multivariate analyses were performed.

resultsAmong 571 patients, 288 (50.4%) reported at least one symptom. Among 410 patients, 148 (36.1%) reported moderate to severe impairment in one or more domains of the EQ-5D-5L. The presence of 90-day symptoms was associated with moderate-severe impairment in the EQ-5D-5L domains of mobility (adjusted OR [aOR], 2.37; 95% CI, 1.22-4.59), usual activities (aOR, 3.66; 95% CI, 1.75-7.65), pain (aOR, 2.43; 95% CI, 1.43-4.12), and anxiety (aOR, 4.32; 95% CI, 2.06-9.02), compared with patients reporting no symptoms There were no differences in symptoms or in the overall EQ-5D-5L index score between treatment groups. Therapeutic-dose heparin was associated with less moderate-severe impairment in all physical functioning domains (mobility, self-care, usual activities) but was independently significant only in the self-care domain (aOR, 0.32; 95% CI, 0.11-0.96).

interpretationIn a randomized controlled trial of hospitalized noncritically ill patients with COVID-19, therapeutic-dose heparin was associated with less severe impairment in the self-care domain of EQ-5D-5L. However, this type of impairment was uncommon, affecting 23 individuals. CLINICAL

trial registrationClinicalTrials.gov; No.: NCT04505774; URL: www. CLINICALTRIALS: gov.

Indexed as

COVID-19HeparinHospitalizationHumansPainQuality of LifeSurveys and QuestionnairesHeparinanticoagulationCOVID-19heparinquality of life

Identifiers

PMID37979717
PMCPMC11026170
OpenAlexW4388754034

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.