Therapeutic-dose heparin increased the probability of survival to hospital discharge with reduced need for organ support in moderately ill COVID-19 patients. While major bleeding was more frequent in the heparin group, the benefits in terms of organ support-free days were substantial enough to warrant consideration of this treatment strategy.

The trial was supported by multiple funding organizations. While these organizations had no role in the design, analysis, or reporting of the results (except for ACTIV-4a where some input was provided), potential conflicts cannot be entirely ruled out. One author disclosed receiving an Early Career Investigator award, another an NIHR Research Professorship, another a Canada Research Chair, and another the Lyonel G. Israels Research Chair.

This large, multi-platform RCT showed a clear benefit of therapeutic-dose heparin in moderately ill, hospitalized COVID-19 patients, improving organ support-free days. The adaptive design is a strength, though the open-label nature and attenuated effect in the final analysis are notable limitations. The funding sources and individual author disclosures raise potential, though not definitive, COI concerns.