A critical question, a unique opportunity...
ETHIC can provide vital evidence for clinicians that low molecular weight heparin (LMWH) may become an evidence-based standard for better care of COVID-19 patients.
The use of LMWH in hospitalised patients with COVID-19 has become standard of care, however, we remain in clinical equipoise regarding the use of LMWH in non-hospitalised patients. There is no hard data supporting the use of these anticoagulants in a community setting. This means that any kind of pharmacological prophylaxis is still off-label use due to the lack of randomised trials.
Thus, gathering evidence to establish the benefit or harm of prescribing LMWH to individuals with COVID-19 in the community is imperative. Prophylactic anticoagulation in a community setting cannot not become routine clinical practice until there is sufficient evidence to support such a decision.
The ETHIC study is designed to provide such evidence. Specifically, ETHIC aims to assess whether prophylactic doses of enoxaparin (compared to no enoxaparin) can reduce hospital admission and/or death within 21 days of randomisation in symptomatic individuals with COVID-19 in a community setting.
Severe COVID-19 infections are associated with a profound prothrombotic state, with large and small vessel thrombosis. Prophylactic anticoagulation with LMWH has been shown to reduce mortality in hospitalised patients ..
However, we remain in uncertainty regarding the use of LMWH in COVID-19 patients in the out-patient-care setting. ETHIC will answer this critical question.
- South Africa
 N. Tang, H. Bai, X. Chen, J. Gong, D. Li, Z. Sun, Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy, Journal of thrombosis and haemostasis : JTH (2020).