Lopes RD, de Barros e Silva PGM, Furtado RHM, et al. - Researchers herein investigated the efficacy and safety of therapeutic vs prophylactic anticoagulation in patients hospitalised with COVID-19. For participation in this pragmatic, open-label (with blinded adjudication), multicenter, randomized, controlled trial conducted at 31 sites in Brazil, they screened 3,331 patients and randomly allocated 615 to receive either therapeutic or prophylactic anticoagulation (311 [50%] were assigned to the therapeutic anticoagulation group and 304 [50%] to the prophylactic anticoagulation group). In patients hospitalized with COVID-19 and elevated D-dimer concentration, no improvement in clinical outcomes and increased bleeding was observed in correlation with in-hospital therapeutic anticoagulation with rivaroxaban or enoxaparin followed by rivaroxaban to day 30 when compared with prophylactic anticoagulation. Hence, they emphasize avoiding use of therapeutic-dose rivaroxaban, and other direct oral anticoagulants, in these patients in the absence of an evidence-based indication for oral anticoagulation.