Jury still out on therapeutic heparin for COVID-19 patients

Therapeutic-dose heparin and LMWH do not improve outcomes in critically ill patients with COVID-19 but may be effective in patients with moderate illness, according to findings from three major studies.

Published in the NEJM, the results from the ACTIV-4a, REMAP-CAP and ATTACC trials showed that in critically ill patients therapeutic heparin did not improve the primary outcome of days without organ support and was associated with more major bleeding complications than usual-care prophylaxis (3.8% vs. 2.3%).

In moderately ill patients, therapeutic-dose heparin or LMWH increased the probability of survival with a reduced need for organ support, but with more major bleeding than with thromboprophylaxis (1.9% vs. 0.9%). An accompanying commentary said the underlying thrombotic and inflammatory damage in severe COVID-19 disease may have been too advanced to have been influenced by higher doses of heparins.

Rituximab biosimilars effective in DLBCL

Patients with diffuse large B-cell lymphoma (DLBCL) have equally good outcomes when treated with biosimilar brands of rituximab compared with the originator brand, a Ducth study has shown.  No difference in three year overall survival was seen between patients with DLBCL treated with rituximab biosimilars as part R-CHOP treatment and patients with DLBCL treated with originator. In a review of outcomes for 876 DLBCL patients who received biosimilars and 3553 who received the originator brand, the 3-year OS did not differ between groups (73% vs 73%, P = .855).

The findings are published in Blood Advances.

Doctors in isolation due to schools COVID-19 cluster

Hundreds of healthcare staff in Queensland including many senior doctors are being forced into isolation and unable to work because they are close contacts of their children attending schools affected by a COVID-19 cluster.

Chief Health Officer Jeannette Young said there were 400 Queensland Health employees now in isolation, including all cardiac surgeons at Queensland’s Children Hospital.

“Several senior doctors have confirmed the schools’ outbreak had potentially put about 50 per cent of surgeons in Brisbane into isolation as their children were attending schools associated with the COVID-19 cluster,” an ABC report said

Many of the healthcare staff are reported to have children among the 6,685 students at elite schools shut down as part of the so-called “Indooroopilly cluster” which includes Brisbane Grammar and Brisbane Girls Grammar School.

The isolation of healthcare staff and closure of hospital departments has forced patients to be diverted from Brisbane to Gold Coast hospitals.