Efficacy and Safety of Intensified Versus Standard Prophylactic Anticoagulation Therapy in Patients With Coronavirus Disease 2019: A Systematic Review and Meta-Analysis.

Autor: Wills NK; Department of Medicine, University of Cape Town, Cape Town, South Africa., Nair N; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada., Patel K; School of Medicine, University of Ottawa, Ottawa, Ontario, Canada., Sikder O; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada., Adriaanse M; Department of Medicine, University of Cape Town, Cape Town, South Africa., Eikelboom J; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada., Wasserman S; Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2022 Jun 07; Vol. 9 (7), pp. ofac285. Date of Electronic Publication: 2022 Jun 07 (Print Publication: 2022).
DOI: 10.1093/ofid/ofac285
Abstrakt: Background: Randomized controlled trials (RCTs) have reported inconsistent effects from intensified anticoagulation on clinical outcomes in coronavirus disease 2019 (COVID-19). We performed an aggregate data meta-analysis from available trials to quantify effect on nonfatal and fatal outcomes and identify subgroups who may benefit.
Methods: We searched multiple databases for RCTs comparing intensified (intermediate or therapeutic dose) vs prophylactic anticoagulation in adults with laboratory-confirmed COVID-19 through 19 January 2022. We used random-effects meta-analysis to estimate pooled risk ratios for mortality, thrombotic, and bleeding events (at end of follow-up or discharge) and performed subgroup analysis for clinical setting and dose of intensified anticoagulation.
Results: Eleven RCTs were included (N = 5873). Intensified vs prophylactic anticoagulation was not associated with a mortality reduction up to 45 days (risk ratio [RR], 0.93 [95% confidence interval {CI}, .79-1.10]). There was a possible signal of mortality reduction for non-intensive care unit (ICU) patients, although with low precision and high heterogeneity (5 studies; RR, 0.84 [95% CI, .49-1.44]; I 2  = 75%). Risk of venous thromboembolism was reduced (RR, 0.53 [95% CI, .41-.69]; I 2  = 0%), with effect driven by therapeutic rather than intermediate dosing (interaction P  = .04). Major bleeding was increased with intensified anticoagulation (RR, 1.73 [95% CI, 1.17-2.56]) with no interaction for dosing and clinical setting.
Conclusions: Intensified anticoagulation has no effect on mortality among hospitalized adults with COVID-19 and is associated with increased bleeding risk. The observed reduction in venous thromboembolism risk and trend toward reduced mortality in non-ICU settings requires exploration in additional RCTs. Clinical Trials Registration. CRD42021273449 (PROSPERO).
(© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze: MEDLINE
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