Abstract
Objective: We aimed to perform a meta-analysis to summarize the overall evidence from randomized controlled trials related to higher-intensity anticoagulation in hospitalized patients with COVID-19.
Methods: A systematic literature search was performed in electronic databases to identify randomized controlled trials comparing the clinical outcomes between intermediate/ therapeutic anticoagulation and prophylactic anticoagulation. Meta-analyses with random-effects models were used to estimate the pooled odds ratio (OR) for outcomes of interest at a 95% confidence interval (CI).
Results: Eight randomized controlled trials were included, with a total of 5405 hospitalized patients with COVID-19. The meta-analysis revealed no statistically significant difference in the odds of mortality (pooled OR = 0.92; 95% CI 0.71-1.19) but a statistically significant reduction in the odds of development of thrombotic events (pooled OR = 0.55; 95% CI 0.42-0.72), and significantly increased odds of development of major bleeding (pooled OR = 1.81; 95% CI 1.20-2.72) with the use of intermediate/therapeutic anticoagulation, relative to prophylactic anticoagulation. Subgroup analysis in patients with a severe course of COVID-19 observed a statistically significant reduction in the odds of development of thrombotic events (pooled OR = 0.66; 95% CI 0.45-0.98) but no significant difference in the odds of development of major bleeding events (pooled OR = 1.37; 95% CI 0.74-2.56), with the use of intermediate/therapeutic anticoagulation, relative to prophylactic anticoagulation.
Conclusion: There could be net clinical benefits with higher-intensity dosing of anticoagulation relative to prophylactic-dosing of anticoagulation among hospitalized patients with severe COVID-19.
Keywords: Anticoagulant; COVID-19; Enoxaparin; Heparin; Mortality; Thromboembolism.
【저자키워드】 COVID-19, Mortality, heparin, enoxaparin, thromboembolism., Anticoagulant, 【초록키워드】 Randomized controlled trial, Meta-analysis, Randomized controlled trials, anticoagulation, severe COVID-19, outcome, Prophylactic, hospitalized patients, heparin, database, clinical outcomes, Clinical outcome, controlled trials, Patient, Thromboembolism, enoxaparin, bleeding, Thrombotic events, prophylactic anticoagulation, therapeutic anticoagulation, Anticoagulant, Evidence, Analysis, meta-analyses, Odds ratio, 95% CI, no significant difference, 95% confidence interval, no statistically significant difference, clinical benefit, statistically significant difference, thrombotic, major bleeding events, subgroup analysis, Random-effects models, random-effects model, systematic literature search, major bleeding, thrombotic event, statistically significant reduction, significantly increased, Course, identify, was performed, were used, hospitalized patient, major bleeding event, with COVID-19, 【제목키워드】 Randomized controlled trial, Clinical outcome, hospitalized patient,