Australia-led international study shows ways to reduce organ failure risk in COVID-19 patients

The Australasian COVID-19 Trial (ASCOT) was conducted with more than 1,500 participants in 32 hospitals across Australia, New Zealand, India and Nepal.

ASCOT Principal Investigator and infectious diseases clinician at the Royal Melbourne Hospital, Professor Steven Tong. Credit: The Peter Doherty Institute for Infection and Immunity

Key Points

• The study reveals the correct dosage of anticoagulation or blood-thinning medication
• There is currently confusion surrounding the appropriate dosage
• The current recommendation in Australia is low dosage
• New findings could change how COVID-19 patients are treated

Researchers at ASCOT recommended Australia and other countries use an intermediate dose of anticoagulant, a blood-thinning medication commonly used to treat clots in patients admitted to the hospital, including those with COVID-19.

ASCOT Principal Investigator and infectious diseases clinician at the Royal Melbourne Hospital, Professor Steven Tong, said early in the pandemic COVID-19 patients had a higher risk of developing clots in their legs and lungs.

"This (blood clotting) may have contributed to people needing to go on a ventilator, or death," Prof Tong told SBS.

The ASCOT study published in the New England Journal of Medicine looked into the effective dosage (low, intermediate or high) of anticoagulants in more than 1,500 COVID patients across Australia, New Zealand, India and Nepal.

The study revealed the intermediate level of blood thinning treatment was most beneficial for non-critically ill COVID patients.

"An intermediate level of anticoagulation had an 86 per cent probability of being better than low dose anticoagulation. A therapeutic (high) dose did not show any benefit," the study said.

"Standard treatment in Australia is to treat patients with low dose anticoagulation while international guidelines recommend therapeutic dose. Our findings suggest intermediate dose may be more beneficial," it added.

Credit: Professor Vivekanand Jha

Professor Vivekanand Jha, executive director at the George Institute for Global Health India and part of the ASCOT trial, said there had been "a fair amount of confusion" about the correct dose of anticoagulation when treating COVID patients.

"Most guidelines suggest using low doses, but some studies showed potentially higher dose was beneficial," Professor Jha said.

"But a higher dose of anticoagulation can be associated with a greater risk of bleeding, potentially causing more harm than good," he added.

Bala Venkatesh, Professorial Fellow at the George Institute for Global Health Australia, said the higher dose of anticoagulation was recommended when little was known about the disease and no vaccination was available earlier in the pandemic.

"Therapeutic doses are normally used to treat established clots and not for prevention," Prof Venkatesh explained.

He said their findings were well received during a presentation at the American Society for Hematology conference. Researchers will now present their findings to the World Health Organization.

However, researchers believe their findings will not lead to an immediate change in the current guidelines but could lead to better protocols moving forward.

The study also highlighted the importance of including low and middle-income countries, which are often under-represented in COVID studies.

"So many trials are done in high-income countries such as North America and Europe, and the findings may not apply as well to a broader ethnic mix," Prof Tong said.

SBS is committed to providing all COVID-19 updates to Australia’s multicultural and multilingual communities. Stay safe and stay informed by visiting regularly the SBS Coronavirus portal, with the latest in your language.