The Impact of Anticoagulation on COVID-19 (SARS CoV-2) Patient Outcomes: A Systematic Review

Lazaridis, Dovena; Leung, Simon; Kohler, Lisa; Smith, Carla Hawkins; Kearson, Margaretta L; Eraikhuemen, Nathaniel

doi:10.1177/08971900211015055

Cited by 9 publications

(7 citation statements)

References 21 publications

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“…23 A systematic review of 4 studies evaluating the impact of anticoagulation on COVID-19 patient outcomes found decreased mortality in these patients with the use of therapeutic doses of anticoagulation. 24 However, the risk of increased bleeding due to anticoagulation must be weighed against the benefits. Oral anticoagulants carry a 13.4% case fatality rate for major bleeds.…”

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confidence: 99%

The Incidence and Mortality Impact of Gastrointestinal Bleeding in Hospitalized COVID-19 Patients

Makker¹,

Mantri²,

Patel³

et al. 2021

CEG

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Background: Patients requiring hospitalization to critical care units are at a higher risk for gastrointestinal (GI) bleeding. Although severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection is predominantly a pulmonary disease, other serious manifestations including thromboembolic phenomenon are reported. Acute respiratory distress syndrome (ARDS) requiring mechanical ventilation, use of steroids and anticoagulation are all known to increase the risk of GI bleeding significantly. Aim: To study the incidence of GI bleeding and its impact on mortality in patients admitted with SARS-CoV-2. Methods: We retrospectively reviewed all patients admitted with SARS-CoV-2 from February 1, 2020 to April 15, 2020. We collected data including demographics, comorbid conditions, laboratory parameters, steroid and anticoagulant use. Coffee ground emesis, hematemesis, melena and hematochezia were defined as GI bleeding. All-cause mortality was reviewed for all patients included in the study. The relationship between GI bleeding and mortality was studied using logistic regression. Results: We had a total of 1206 patients hospitalized with SARS-CoV-2 infection with an all-cause mortality of 34% (n = 411). The overall incidence of GI bleeding was 3.1% (n = 37) with no significant difference between the patients who survived versus died during hospitalization (1.3% vs 1.5%, p = 0.77). Logistic regression analysis did not identify GI bleeding as an independent predictor of mortality. Therapeutic doses of anticoagulation were administered in 13.3% (n = 161) of patients, of which 6.8% (n = 11) developed GI bleeding. Patients were more likely to develop GI bleeding with use of therapeutic doses of anticoagulation (29.7% vs 12.8%, p = 0.003), steroids (37.8% vs 18.5%, p = 0.003) and mechanical ventilation (48.6% vs 30.4%, p = 0.018). Conclusion:Patients hospitalized with SARS-CoV-2 infection are at risk of gastrointestinal bleeding. Therapeutic doses of anticoagulation, mechanical ventilation and steroid use are significant risk factors for GI bleeding. However, GI bleeding did not significantly alter the mortality rates in SARS-CoV-2-infected patients.

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confidence: 99%

The Incidence and Mortality Impact of Gastrointestinal Bleeding in Hospitalized COVID-19 Patients

Makker¹,

Mantri²,

Patel³

et al. 2021

CEG

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“…Multiple systematic reviews and meta-analyses reported variable VTE incidence in patients with COVID-19 according to the diagnostic approach, whether passive upon presentation of clinical manifestation (9.5%) or active search (14.1%), 26 and critical clinical condition, regardless of the patient being in intensive care (13.7%) or on ward beds (3.5%). 1 , 2 , 4 , 12 , 18 , 19 , 20 , 21 When in intensive care and under an active diagnostic search protocol, the incidence of VTE can increase up to 4 times, with a prevalence of 48% (95% Confidence Interval, 95% CI: 0.33 to 0.63). 2 There is even a discussion about whether patients with COVID-19 develop more thrombosis compared to non-COVID-19 patients with the same severity.…”

Section: Discussionmentioning

confidence: 99%

“…During the COVID-19 pandemic, however, the application of this knowledge became difficult for those involved in direct patient care due to the multiplicity and variation in the recommendations for thromboprophylaxis, 17 , 18 as well as the low or very low quality of the studies that such recommendations were based on. 19 , 20 One reason may be due to the COVID-19 infection itself and its severe disease pathogenesis, which was then (and still is) in the discovery phase. In addition, the risk stratification approaches used among the patients studied and the anticoagulation strategies, with their recommended drugs and dosages, showed significant heterogeneity.…”

Section: Introductionmentioning

confidence: 99%

Immunothrombosis and COVID-19 ‒ a nested post-hoc analysis from a 3186 patient cohort in a Latin American public reference hospital

Lima¹,

Gonçalves²,

Besen³

et al. 2023

Clinics

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“…A systematic review of 64 studies associated an improvement in pulmonary oxygenation, decreased coagulopathy markers, and decreased mortality in COVID-19 patients with prophylaxis and high dose anticoagulation. [45] Another study showed a significant decrease in mortality in COVID-19 patients receiving anticoagulation. Prophylactic anticoagulation had an RR of mortality of 0.54, and therapeutic anticoagulation showed a relative risk of mortality of 0.4.…”

Section: Discussionmentioning

confidence: 99%

Effect of combination of prophylactic or therapeutic anticoagulation with aspirin on the outcomes of hospitalized COVID-19 patients: An observational retrospective study

Mina,

Fleifel,

Haykal

et al. 2023

Medicine

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Regimens for managing thromboembolic complications of COVID-19 are still not very well established. The present study compares the clinical characteristics and outcomes of patients hospitalized with COVID-19 receiving different anticoagulation regimens with and without aspirin. This is a retrospective observational study of 491 patients hospitalized for COVID-19 from August 2020 to April 2021. Data regarding clinical characteristics, laboratory findings, and outcomes of patients receiving different anticoagulation with and without aspirin regimens was collected, according to which 5 patient groups were defined: received no anticoagulation (NAA), prophylactic anticoagulation with (PA) or without aspirin (PAA) and therapeutic anticoagulation with (TA) or without aspirin (TAA). The average age was highest in the TAA group. Desaturation was highest in the TA and TAA groups. Diabetes, hypertension, dyslipidemia and coronary artery disease were the most prevalent in aspirin groups (PAA and TAA) as was heart failure in the TA and TAA groups and cancer in the TA and PAA groups. Elevated troponin was observed in the PAA and TAA groups. TA and TAA patients received oxygen therapy, needed ICU admission overall, and required invasive ventilation and vasopressors the most. Prophylactic anticoagulation groups (PA and PAA) had the highest patient survival rates. Patients with severe COVID-19 infections were more likely to receive higher, therapeutic, anticoagulation doses. Aspirin was given to patients with preexisting comorbidities, but it had no statistically significant impact on the outcomes of the different groups. Groups receiving prophylactic anticoagulation had the best survival outcomes.

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The Impact of Anticoagulation on COVID-19 (SARS CoV-2) Patient Outcomes: A Systematic Review

Cited by 9 publications

References 21 publications

The Incidence and Mortality Impact of Gastrointestinal Bleeding in Hospitalized COVID-19 Patients

The Incidence and Mortality Impact of Gastrointestinal Bleeding in Hospitalized COVID-19 Patients

Immunothrombosis and COVID-19 ‒ a nested post-hoc analysis from a 3186 patient cohort in a Latin American public reference hospital

Effect of combination of prophylactic or therapeutic anticoagulation with aspirin on the outcomes of hospitalized COVID-19 patients: An observational retrospective study

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