The Use of Therapeutic-Dose Anticoagulation and Its Effect on Mortality in Patients With COVID-19: A Systematic Review

Wijaya, Indra; Andhika, Rizky; Huang, Ian

doi:10.1177/1076029620960797

Cited by 49 publications

(53 citation statements)

References 38 publications

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“…Observational studies identified an association between the novel coronavirus disease 2019 (Covid- 19), inflammation, hypercoagulability, and thrombosis. [1][2][3][4] Critically ill patients with Covid-19 are at high risk of venous and arterial thrombotic events despite standard dose pharmacological thromboprophylaxis.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Anticoagulation in Critically Ill Patients with Covid-19 – Preliminary Report

Zarychanski

2021

Preprint

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Background Thrombosis may contribute to morbidity and mortality in Covid-19. We hypothesized that therapeutic anticoagulation would improve outcomes in critically ill patients with Covid-19. Methods We conducted an open-label, adaptive, multiplatform, randomized, clinical trial. Patients with severe Covid-19, defined as the requirement for organ support with high flow nasal cannula, non-invasive ventilation, invasive ventilation, vasopressors, or inotropes, were randomized to receive therapeutic anticoagulation with heparin or pharmacological thromboprophylaxis as per local usual care. The primary outcome was an ordinal scale combining in-hospital mortality (assigned -1) and days free of organ support to day 21. Results Therapeutic anticoagulation met the pre-defined criteria for futility in patients with severe Covid-19. The primary outcome was available for 1,074 participants (529 randomized to therapeutic anticoagulation and 545 randomized to usual care pharmacological thromboprophylaxis). Median organ support-free days were 3 days (interquartile range -1, 16) in patients assigned to therapeutic anticoagulation and 5 days (interquartile range -1, 16) in patients assigned to usual care pharmacological thromboprophylaxis (adjusted odds ratio 0.87, 95% credible interval (CrI) 0.70-1.08, posterior probability of futility [odds ratio<1.2] 99.8%). Hospital survival was comparable between groups (64.3% vs. 65.3%, adjusted odds ratio 0.88, 95% CrI 0.67-1.16). Major bleeding occurred in 3.1% of patients assigned to therapeutic anticoagulation and 2.4% of patients assigned to usual care pharmacological thromboprophylaxis. Conclusions In patients with severe Covid-19, therapeutic anticoagulation did not improve hospital survival or days free of organ support compared to usual care pharmacological thromboprophylaxis.

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Section: Introductionmentioning

confidence: 99%

Therapeutic Anticoagulation in Critically Ill Patients with Covid-19 – Preliminary Report

Zarychanski

2021

Preprint

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“…However, there is still a time gap before the global vaccination could finally be completed. In the meantime, we still need to take preventive measures for COVID-19 and its fatal complications by not only controlling specific chronic comorbidities [ 1 – 4 ], but also seeking the possible adjunctive treatment for patients already in severe COVID-19 condition [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

In-hospital use of statins is associated with a reduced risk of mortality in coronavirus-2019 (COVID-19): systematic review and meta-analysis

et al. 2021

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Background and aims The idea of treating COVID-19 with statins is biologically plausible, although it is still controversial. The systematic review and meta-analysis aimed to address the association between the use of statins and risk of mortality in patients with COVID-19. Methods Several electronic databases, including PubMed, SCOPUS, EuropePMC, and the Cochrane Central Register of Controlled Trials, with relevant keywords up to 11 November 2020, were used to perform a systematic literature search. This study included research papers containing samples of adult COVID-19 patients who had data on statin use and recorded mortality as their outcome of interest. Risk estimates of mortality in statin users versus non-statin users were pooled across studies using inverse-variance weighted DerSimonian-Laird random-effect models. Results Thirteen studies with a total of 52,122 patients were included in the final qualitative and quantitative analysis. Eight studies reported in-hospital use of statins; meanwhile, the remaining studies reported pre-admission use of statins. In-hospital use of statin was associated with a reduced risk of mortality (RR 0.54, 95% CI 0.50–0.58, p < 0.00001; I 2 : 0%, p = 0.87), while pre-admission use of statin was not associated with mortality (RR 1.18, 95% CI 0.79–1.77, p = 0.415; I 2 : 68.6%, p = 0.013). The funnel plot for the association between the use of statins and mortality were asymmetrical. Conclusion This meta-analysis showed that in-hospital use of statins was associated with a reduced risk of mortality in patients with COVID-19.

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“…The disease then rapidly spread worldwide, and the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) as a global public health emergency [1]. The spectrum of the disease ranges from asymptomatic to fatal multiorgan failure with features of hyperinflammation and hypercoagulable state [2][3][4][5]. Cardiac arrhythmias in COVID-19 are gaining attention as potential complications of SARS-CoV-2 because of its association with increased risk of poor outcome in COVID-19 [6,7].…”

Section: Introductionmentioning

confidence: 99%

Challenge in diagnosis of COVID-19 in hemodialysis patient: a case report and brief review of the literature

et al. 2021

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Diagnosis of COVID-19 in end-stage kidney disease (ESKD) patients on hemodialysis is challenging, as the symptoms are often atypical. Herein, we reported a confimed case of COVID-19 in a patient on maintenance hemodialysis. A 38-year-old man with ESKD on regular hemodialysis initially presented with progressive shortness of breath and dry cough, without fever. He had lymphopenia, and chest X-ray suggested pulmonary edema with cardiomegaly and suspected bilateral bronchopneumonia. The patient clinically improved after 7 days of hospitalization, and was subsequently discharged from hospital. Ten days after being discharged, the patient was re-admitted with progressive shortness of breath and dry cough, without fever. SARS-CoV-2 infection was later confirmed by a qualitative RT-PCR test and the diagnosis COVID-19 pneumonia was established. We presented a case of atypical presentation of COVID-19 in an ESKD patient on maintenance hemodialysis with a brief review of the current literature.

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The Use of Therapeutic-Dose Anticoagulation and Its Effect on Mortality in Patients With COVID-19: A Systematic Review

Cited by 49 publications

References 38 publications

Therapeutic Anticoagulation in Critically Ill Patients with Covid-19 – Preliminary Report

Therapeutic Anticoagulation in Critically Ill Patients with Covid-19 – Preliminary Report

In-hospital use of statins is associated with a reduced risk of mortality in coronavirus-2019 (COVID-19): systematic review and meta-analysis

Challenge in diagnosis of COVID-19 in hemodialysis patient: a case report and brief review of the literature

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