The MICHELLE Trial

Dr. Paul Dobesh discusses the MICHELLE trial with co-host, Dr. Tracy Macaulay.

0:00-1:00: Introduction

1:01-4:14: MICHELLE trial overview

4:15-11:10: Risk stratification and current recommendations for thromboprophylaxis

11:11-19:43: Thoughts on the MICHELLE trial and application to current practice

19:44-23:00: Future directions

23:01-24:03: Closing

References:

MICHELLE

Ramacciotti E, Barile Agati L, Calderaro D, et al. Rivaroxaban versus no anticoagulation for post-discharge thromboprophylaxis after hospitalisation for COVID-19 (MICHELLE): an open-label, multicentre, randomised, controlled trial. Lancet. 2022;399(10319):50-59. doi:10.1016/S0140-6736(21)02392-8

ADOPT

Goldhaber SZ, Leizorovicz A, Kakkar AK, et al. Apixaban versus enoxaparin for thromboprophylaxis in medically ill patients. N Engl J Med. 2011;365(23):2167-2177. doi:10.1056/NEJMoa1110899

MAGELLAN

Cohen AT, Spiro TE, Büller HR, et al. Rivaroxaban for thromboprophylaxis in acutely ill medical patients. N Engl J Med. 2013;368(6):513-523. doi:10.1056/NEJMoa1111096

APEX

Cohen AT, Harrington RA, Goldhaber SZ, et al. Extended Thromboprophylaxis with Betrixaban in Acutely Ill Medical Patients. N Engl J Med. 2016;375(6):534-544. doi:10.1056/NEJMoa1601747

ACTION

Lopes RD, de Barros E Silva PGM, Furtado RHM, et al. Therapeutic versus prophylactic anticoagulation for patients admitted to hospital with COVID-19 and elevated D-dimer concentration (ACTION): an open-label, multicentre, randomised, controlled trial. Lancet. 2021;397(10291):2253-2263. doi:10.1016/S0140-6736(21)01203-4

ACTIV-4B

Connors JM, Brooks MM, Sciurba FC, et al. Effect of Antithrombotic Therapy on Clinical Outcomes in Outpatients With Clinically Stable Symptomatic COVID-19: The ACTIV-4B Randomized Clinical Trial. JAMA.2021;326(17):1703–1712. doi:10.1001/jama.2021.17272

Dobesh PP, Trujillo TC. Coagulopathy, Venous Thromboembolism, and Anticoagulation in Patients with COVID-19. Pharmacotherapy. 2020;40(11):1130-1151. doi:10.1002/phar.2465

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