tetano
Editor, Senior Moderator
J Clin Med
. 2021 Dec 23;11(1):57.
doi: 10.3390/jcm11010057.
Safety and Efficacy of Intermediate- and Therapeutic-Dose Anticoagulation for Hospitalised Patients with COVID-19: A Systematic Review and Meta-Analysis
Stefanie Reis[SUP] 1 [/SUP], Maria Popp[SUP] 1 [/SUP], Benedikt Schmid[SUP] 1 [/SUP], Miriam Stegemann[SUP] 2 [/SUP], Maria-Inti Metzendorf[SUP] 3 [/SUP], Peter Kranke[SUP] 1 [/SUP], Patrick Meybohm[SUP] 1 [/SUP], Stephanie Weibel[SUP] 1 [/SUP]
Affiliations
Abstract
Background: COVID-19 patients are at high thrombotic risk. The safety and efficacy of different anticoagulation regimens in COVID-19 patients remain unclear.
Methods: We searched for randomised controlled trials (RCTs) comparing intermediate- or therapeutic-dose anticoagulation to standard thromboprophylaxis in hospitalised patients with COVID-19 irrespective of disease severity. To assess efficacy and safety, we meta-analysed data for all-cause mortality, clinical status, thrombotic event or death, and major bleedings.
Results: Eight RCTs, including 5580 patients, were identified, with two comparing intermediate- and six therapeutic-dose anticoagulation to standard thromboprophylaxis. Intermediate-dose anticoagulation may have little or no effect on any thrombotic event or death (RR 1.03, 95% CI 0.86-1.24), but may increase major bleedings (RR 1.48, 95% CI 0.53-4.15) in moderate to severe COVID-19 patients. Therapeutic-dose anticoagulation may decrease any thrombotic event or death in patients with moderate COVID-19 (RR 0.64, 95% CI 0.38-1.07), but may have little or no effect in patients with severe disease (RR 0.98, 95% CI 0.86-1.12). The risk of major bleedings may increase independent of disease severity (RR 1.78, 95% CI 1.15-2.74).
Conclusions: Certainty of evidence is still low. Moderately affected COVID-19 patients may benefit from therapeutic-dose anticoagulation, but the risk for bleeding is increased.
Keywords: anticoagulant therapy; bleeding; coronavirus disease 2019; death; thrombosis.
. 2021 Dec 23;11(1):57.
doi: 10.3390/jcm11010057.
Safety and Efficacy of Intermediate- and Therapeutic-Dose Anticoagulation for Hospitalised Patients with COVID-19: A Systematic Review and Meta-Analysis
Stefanie Reis[SUP] 1 [/SUP], Maria Popp[SUP] 1 [/SUP], Benedikt Schmid[SUP] 1 [/SUP], Miriam Stegemann[SUP] 2 [/SUP], Maria-Inti Metzendorf[SUP] 3 [/SUP], Peter Kranke[SUP] 1 [/SUP], Patrick Meybohm[SUP] 1 [/SUP], Stephanie Weibel[SUP] 1 [/SUP]
Affiliations
- PMID: 35011804
- DOI: 10.3390/jcm11010057
Abstract
Background: COVID-19 patients are at high thrombotic risk. The safety and efficacy of different anticoagulation regimens in COVID-19 patients remain unclear.
Methods: We searched for randomised controlled trials (RCTs) comparing intermediate- or therapeutic-dose anticoagulation to standard thromboprophylaxis in hospitalised patients with COVID-19 irrespective of disease severity. To assess efficacy and safety, we meta-analysed data for all-cause mortality, clinical status, thrombotic event or death, and major bleedings.
Results: Eight RCTs, including 5580 patients, were identified, with two comparing intermediate- and six therapeutic-dose anticoagulation to standard thromboprophylaxis. Intermediate-dose anticoagulation may have little or no effect on any thrombotic event or death (RR 1.03, 95% CI 0.86-1.24), but may increase major bleedings (RR 1.48, 95% CI 0.53-4.15) in moderate to severe COVID-19 patients. Therapeutic-dose anticoagulation may decrease any thrombotic event or death in patients with moderate COVID-19 (RR 0.64, 95% CI 0.38-1.07), but may have little or no effect in patients with severe disease (RR 0.98, 95% CI 0.86-1.12). The risk of major bleedings may increase independent of disease severity (RR 1.78, 95% CI 1.15-2.74).
Conclusions: Certainty of evidence is still low. Moderately affected COVID-19 patients may benefit from therapeutic-dose anticoagulation, but the risk for bleeding is increased.
Keywords: anticoagulant therapy; bleeding; coronavirus disease 2019; death; thrombosis.