Safety and efficacy of intermediate- and therapeutic-dose anticoagulation for hospitalised patients with COVID-19: a systematic review and meta-analysis
Please always quote using this URN: urn:nbn:de:bvb:20-opus-252285
- 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,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.…
| Author: | Stefanie Reis, Maria Popp, Benedikt Schmid, Miriam Stegemann, Maria-Inti Metzendorf, Peter Kranke, Patrick MeybohmORCiD, Stephanie Weibel |
|---|---|
| URN: | urn:nbn:de:bvb:20-opus-252285 |
| Document Type: | Journal article |
| Faculties: | Medizinische Fakultät / Klinik und Poliklinik für Anästhesiologie (ab 2004) |
| Language: | English |
| Parent Title (English): | Journal of Clinical Medicine |
| ISSN: | 2077-0383 |
| Year of Completion: | 2021 |
| Volume: | 11 |
| Issue: | 1 |
| Article Number: | 57 |
| Source: | Journal of Clinical Medicine (2022) 11:1, 57. https://doi.org/10.3390/jcm11010057 |
| DOI: | https://doi.org/10.3390/jcm11010057 |
| Dewey Decimal Classification: | 6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit |
| Tag: | anticoagulant therapy; bleeding; coronavirus disease 2019; death; thrombosis |
| Release Date: | 2022/09/12 |
| Date of first Publication: | 2021/12/23 |
| Licence (German): |  CC BY: Creative-Commons-Lizenz: Namensnennung 4.0 International |