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 [1]..

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.

Want to take action?

If you or a physician in your network is eligible to enrol patients for this trial (i.e. you practice in one of our participating countries).

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Participating countries:

  • UK
  • Belgium
  • Spain
  • Russia
  • South Africa
  • Brazil
  • Australia
  • Germany
  • India

[1] 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).