Lopes RD, de Barros e Silva PGM, Furtado RHM, et al. - Researchers aimed at comparing the efficacy and safety of therapeutic vs prophylactic anticoagulation in patients hospitalized with COVID-19. In this pragmatic, open-label (with blinded adjudication), multicenter, randomized, controlled trial conducted at 31 sites in Brazil, they randomly assigned patients (aged ≥18 years) hospitalized with COVID-19 and elevated D-dimer concentration, and who had COVID-19 symptoms for up to 14 days before randomization, to receive either therapeutic or prophylactic anticoagulation. In these patients, in-hospital therapeutic anticoagulation with rivaroxaban or enoxaparin followed by rivaroxaban to day 30 did not result in improvement in clinical outcomes and increase in bleeding compared with prophylactic anticoagulation. Hence, they recommend avoiding the use of therapeutic-dose rivaroxaban, and other direct oral anticoagulants, in these patients in the absence of an evidence-based indication for oral anticoagulation.