Optimal dosing of heparin for prophylactic anticoagulation in critically ill COVID-19 patients a systematic review and meta-analysis of randomized controlled trials.

Autor: Bonfim LCMG; Department of Medicine, University of South Santa Catarina, Florianópolis, SC, Brazil. Electronic address: luanacarolinemgb@gmail.com., Guerini IS; Department of Medicine, State University of Western Paraná, Francisco Beltrão, PR, Brazil., Zambon MG; Department of Medicine, Mackenzie Evangelical University Hospital, Curitiba, PR, Brazil., Pires GB; Department of Medicine, School of Medicine Souza Marques, Rio de Janeiro, RJ, Brazil., Silva ACF; Department of Medicine, Federal University of Santa Catarina, Florianópolis, SC, Brazil., Gobatto ALN; Department of Critical Care, São Rafael Hospital, Salvador, Bahia, Brazil; Department of Critical Care, Hospital da Cidade, Salvador, Bahia, Brazil., Lopes MA; Department of Critical Care, Hospital da Cidade, Salvador, Bahia, Brazil., Brosnahan SB; Department of Pulmonary and Critical Care, New York University School of Medicine, New York, NY, USA.
Jazyk: angličtina
Zdroj: Journal of critical care [J Crit Care] 2023 Oct; Vol. 77, pp. 154344. Date of Electronic Publication: 2023 May 25.
DOI: 10.1016/j.jcrc.2023.154344
Abstrakt: Purpose: The optimal amount of anticoagulation for critically ill COVID-19 patients is controversial. Therefore, we aimed to evaluate the efficacy and safety of escalated doses of anticoagulation in critically ill patients with severe COVID-19.
Materials and Methods: We conducted a systematic search of three major databases, including PubMed, Cochrane Library, and Embase, from inception to May 2022. Randomized controlled trials (RCTs) were included comparing therapeutic or intermediate doses to standard prophylactic doses of anticoagulants in critically ill COVID-19 patients, with heparins as the only anticoagulation therapy considered.
Results: Out of the six RCTs, 2130 patients were administered escalated dose anticoagulation (50.2%) and standard thromboprophylaxis therapy (49.8%). The escalated dose showed no significant impact on mortality (RR, 1.01; 95% CI, 0.90-1.13). Although there was no significant difference in DVT (RR, 0.81; 95% CI, 0.61-1.08), the risk of PE was significantly reduced in patients receiving escalated dose anticoagulation (RR, 0.35; 95% CI, 0.21-0.60), with an increased risk of bleeding events (RR, 1.65; 95% CI, 1.08-2.53).
Conclusion: This systematic review and meta-analysis fail to support escalated anticoagulation doses to reduce mortality in critically ill COVID-19 patients. However, higher doses of anticoagulants appear to reduce thrombotic events while increasing the risk of bleeding effectively.
Competing Interests: Declaration of Competing Interest Not declared.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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