Blood-thinning drug is ineffective at aiding Covid-19 recovery, finds Cambridge-led HEAL-COVID trial

A blood-thinning drug often given to patients who have had moderate and severe Covid-19 does not help them recover, a UK trial led by Addenbrooke’s Hospital and the University of Cambridge has found.

The finding will save patients from the risk of serious side effects from the anticoagulant therapy and the search for beneficial treatments continues, with the trial now focusing on a statin.

More than 990,000 people have been admitted to UK hospitals with Covid, and more than 1,000 of them have taken part in the HEAL-COVID platform trial that aims to find treatments that reduce the numbers who die or who are readmitted following their time in hospital.

The first trial results found that prescribing the oral anticoagulant Apixaban for these patients - which had been widely thought to work - was not in fact successful at aiding their recovery from Covid, with 29.1 per cent given the drug later dying or being readmitted to hospital over the following year, compared to 30.8 per cent given the standard care.

Anticoagulant therapy, designed to prevent blood clots, has known serious side effects, some of which were experienced by participants in the trial.

A small number of the 402 patients in the trial who were given Apixaban suffered major bleeding that required them to discontinue the treatment.

There was also no difference in the number of patients alive or out of hospital 60 days after they were deemed ready to go home whether they had been given the drug or standard care.

Prof Charlotte Summers, chief investigator for the trial and an intensive care specialist at Addenbrooke’s and the University of Cambridge, said: “Having survived the ordeal of being hospitalised with Covid-19, far too many patients find themselves back in hospital, often developing longer-term complications as a result of the virus.

“There is an urgent need for us to find treatments that prevent this significant burden of illness and improve the lives of so many still being affected by Covid.

“These first findings from HEAL-COVID show us that a blood thinning drug, commonly thought to be a useful intervention in the post-hospital phase, is actually ineffective at stopping people dying or being readmitted to hospital.

“This finding is important because it will prevent unnecessary harm occurring to people for no benefit. It also means we must continue our search for therapies that improve longer term recovery for this devastating disease.”

Dr Mark Toshner, joint chief investigator for HEAL-COVID, said: “Up until now it’s been assumed that Apixaban helps patients recover after severe Covid-19 and that thinning their blood to prevent clots is beneficial. This trial is the first robust evidence that longer anticoagulation after acute Covid-19 puts patients at risk for no clear benefit.

“Our hope is that these results will stop this drug being needlessly prescribed to patients with Covid-19 and we can change medical practice. Finding out that a treatment doesn’t work is really important. It’s not the solution many hoped it would be, with our results highlighting once again why testing treatments in randomised trials is important.

“At present, the world’s research efforts have focussed on acute Covid-19. We now urgently need evidence about how to best treat patients beyond their initial infection.”

The trial will now focus on testing a cholesterol-busting drug, or statin, called Atorvastatin that acts on other mechanisms of disease thought to be important in Covid.

Prof Nick Lemoine, NIHR Clinical Research Network medical director, said: “Research into Covid-19 recovery remains vital as we move out of the pandemic. Results such as these from the HEAL-COVID study, help to strengthen our knowledge of how patients can be treated following their stay in hospital and how recovery rates can be improved upon.

“Findings from clinical trials, whether they identify new treatments or rule out methods of care, are vital and rigorous evidence when it comes to changing best medical practice.”

Latest figures from the Office for National Statistics tracking the outcomes of 47,780 people discharged after a hospital admission for Covid-19 showed:

• Half were of working age, with the average age 64.5 years;
• 29.3 per cent of them were readmitted to hospital within about six months; and
• 12.3 per cent died within about six months of hospital discharge.

The HEAL-COVID trial is being led by Cambridge University Hospitals NHS Foundation Trust (CUH) and University of Cambridge, in collaboration with Liverpool Clinical Trials Centre at the University of Liverpool and software provider Aparito Limited.