The impact of different prophylactic anticoagulation doses on the outcomes of patients with COVID-19

Jiménez-Soto, Rodolfo; Aguilar-Soto, Mercedes; Rodríguez-Toledo, Carlos Andrés; Camiro-Zúñiga, Antonio; Demichelis‐Gómez, Roberta

doi:10.1016/j.thromres.2021.02.031

Cited by 9 publications

(20 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Among the 8318 articles initially retrieved through our literature search, 21 fulfilled the inclusion criteria and were included in our analysis [ 11 , 12 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. The PRISMA 2020 flow diagram for systematic reviews and meta-analyses study selection is presented in Supplementary File, Figure S1 .…”

Section: Resultsmentioning

confidence: 99%

“…The PRISMA 2020 flow diagram for systematic reviews and meta-analyses study selection is presented in Supplementary File, Figure S1 . A total of 7 studies reported data for intermediate versus prophylactic dose [ 11 , 27 , 28 , 29 , 30 , 34 , 35 ], while 17 studies reported data for therapeutic versus prophylactic dose of thromboprophylaxis [ 12 , 23 , 24 , 25 , 26 , 29 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. Three studies contributed data for both intermediate versus prophylactic and therapeutic versus prophylactic dose analyses [ 29 , 34 , 35 ].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

High versus Standard Intensity of Thromboprophylaxis in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

Kyriakoulis

Trontzas

Rapti

et al. 2021

JCM

View full text Add to dashboard Cite

Thromboprophylaxis in hospitalized patients with COVID-19 has been associated with a survival benefit and is strongly recommended. However, the optimal dose of thromboprophylaxis remains unclear. A systematic review and meta-analysis (PubMed/EMBASE) of studies comparing high (intermediate or therapeutic dose) versus standard (prophylactic dose) intensity of thrombo-prophylaxis with regard to outcome of hospitalized patients with COVID-19 was performed. Randomized and non-randomized studies that provided adjusted effect size estimates were included. Meta-analysis of 7 studies comparing intermediate versus prophylactic dose of thromboprophylaxis (2 randomized and 5 observational, n = 2009, weighted age 61 years, males 61%, ICU 53%) revealed a pooled adjusted relative risk (RR) for death at 0.56 (95% confidence intervals (CI) 0.34, 0.92) in favor of the intermediate dose. For the same comparison arms, the pooled RR for venous thromboembolism was 0.84 (95% CI 0.54, 1.31), and for major bleeding events was 1.63 (95% CI 0.79, 3.37). Meta-analysis of 17 studies comparing therapeutic versus prophylactic dose of thromboprophylaxis (2 randomized and 15 observational, n = 7776, weighted age 64 years, males 54%, ICU 21%) revealed a pooled adjusted RR for death at 0.73 (95% CI 0.47, 1.14) for the therapeutic dose. An opposite trend was observed in the unadjusted analysis of 15 observational studies (RR 1.24 (95% CI 0.88, 1.74)). For the same comparison arms, the pooled RR for venous thromboembolism was 1.13 (95% CI 0.52, 2.48), and for major bleeding events 3.32 (95% CI 2.51, 4.40). In conclusion, intermediate compared with standard prophylactic dose of thromboprophylaxis appears to be rather safe and is associated with additional survival benefit, although most data are derived from observational retrospective analyses. Randomized studies are needed to define the optimal thromboprophylaxis in hospitalized patients with COVID-19.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

High versus Standard Intensity of Thromboprophylaxis in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

Kyriakoulis

Trontzas

Rapti

et al. 2021

JCM

View full text Add to dashboard Cite

show abstract

“…Eighteen studies [ 34 , 40 , 42 , 48 , 51 , 53 – 55 , 57 , 62 – 66 , 68 – 70 , 73 ] reported results from the United States and two [ 37 , 38 ] were international studies. Other studies originated from eleven countries ( Italy [ 47 , 49 , 56 , 58 , 60 , 72 , 75 ], France [ 41 , 61 , 67 ], Brazil [ 35 , 36 ], England [ 59 ], Greek [ 46 ], China [ 45 ], Japan [ 43 ], Mexico [ 44 ], United Arab Emirates [ 52 , 71 ], Turkey [ 74 ], Iran [ 39 ] and Spain [ 50 ] ).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…We included a pooled population of 23,579 hospitalized COVID-19 patients [ 34 – 49 , 51 – 61 , 63 – 68 , 70 – 75 ] with reported information related to in-hospital mortality, 19,275 patients [ 34 – 41 , 44 , 46 – 48 , 50 , 51 , 53 , 55 , 58 , 59 , 61 , 62 , 64 – 67 , 70 , 71 , 73 ] with reported information related to bleeding events and 8492 patients [ 34 – 39 , 41 – 43 , 47 , 56 , 58 , 60 – 62 , 64 , 66 ] with reported information related to thrombotic events. The mean age in most studies was over 60 years.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…A total of 27 studies [ 34 – 41 , 44 , 46 – 48 , 50 , 51 , 53 , 55 , 58 , 59 , 61 , 62 , 64 – 67 , 70 , 71 , 73 ] including 19,275 patients assessed the incidence of any bleeding events in intermediate-to-therapeutic anticoagulation group and prophylactic anticoagulation group. COVID-19 patients admitted to general wards, the average incidence of any bleeding events was 2.27 % in prophylactic anticoagulation and 5.50 % in intermediate-to-therapeutic anticoagulation group.…”

Section: Bleeding Eventsmentioning

confidence: 99%

See 1 more Smart Citation

Intermediate-to-therapeutic versus prophylactic anticoagulation for coagulopathy in hospitalized COVID-19 patients: a systemic review and meta-analysis

Zhang

Liu

et al. 2021

Thrombosis J

View full text Add to dashboard Cite

Background Anticoagulation in hospitalized COVID-19 patients has been associated with survival benefit; however, the optimal anticoagulant strategy has not yet been defined. The objective of this meta-analysis was to investigate the effect of intermediate-to-therapeutic versus prophylactic anticoagulation for thromboprophylaxis on the primary outcome of in-hospital mortality and other patient-centered secondary outcomes in COVID-19 patients. Methods MEDLINE, EMBASE, and Cochrane databases were searched from inception to August 10th 2021. Cohort studies and randomized clinical trials that assessed the efficacy and safety of intermediate-to-therapeutic versus prophylactic anticoagulation in hospitalized COVID-19 patients were included. Baseline characteristics and relevant data of each study were extracted in a pre-designed standardized data-collection form. The primary outcome was all-cause in-hospital mortality and the secondary outcomes were incidence of thrombotic events and incidence of any bleeding and major bleeding. Pooled analysis with random effects models yielded relative risk with 95 % CIs. Results This meta-analysis included 42 studies with 28,055 in-hospital COVID-19 patients totally. Our pooled analysis demonstrated that intermediate-to-therapeutic anticoagulation was not associated with lower in-hospital mortality (RR=1.12, 95 %CI 0.99-1.25, p=0.06, I2=77 %) and lower incidence of thrombotic events (RR=1.30, 95 %CI 0.79-2.15, p=0.30, I2=88 %), but increased the risk of any bleeding events (RR=2.16, 95 %CI 1.79-2.60, p<0.01, I2=31 %) and major bleeding events significantly (RR=2.10, 95 %CI 1.77-2.51, p<0.01, I2=11 %) versus prophylactic anticoagulation. Moreover, intermediate-to-therapeutic anticoagulation decreased the incidence of thrombotic events (RR=0.71, 95 %CI 0.56-0.89, p=0.003, I2=0 %) among critically ill COVID-19 patients admitted to intensive care units (ICU), with increased bleeding risk (RR=1.66, 95 %CI 1.37-2.00, p<0.01, I2=0 %) and unchanged in-hospital mortality (RR=0.94, 95 %CI 0.79-1.10, p=0.42, I2=30 %) in such patients. The Grading of Recommendation, Assessment, Development, and Evaluation certainty of evidence ranged from very low to moderate. Conclusions We recommend the use of prophylactic anticoagulation against intermediate-to-therapeutic anticoagulation among unselected hospitalized COVID-19 patients considering insignificant survival benefits but higher risk of bleeding in the escalated thromboprophylaxis strategy. For critically ill COVID-19 patients, the benefits of intermediate-to-therapeutic anticoagulation in reducing thrombotic events should be weighed cautiously because of its association with higher risk of bleeding. Trial registration The protocol was registered at PROSPERO on August 17th 2021 (CRD42021273780). Graphical abstract

show abstract

Anticoagulants for people hospitalised with COVID-19

Flumignan

Civile

Tinôco

et al. 2022

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

The impact of different prophylactic anticoagulation doses on the outcomes of patients with COVID-19

Cited by 9 publications

References 9 publications

High versus Standard Intensity of Thromboprophylaxis in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

High versus Standard Intensity of Thromboprophylaxis in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

Intermediate-to-therapeutic versus prophylactic anticoagulation for coagulopathy in hospitalized COVID-19 patients: a systemic review and meta-analysis

Anticoagulants for people hospitalised with COVID-19

Contact Info

Product

Resources

About