Anticoagulation and In-Hospital Mortality From Coronavirus Disease 2019: A Systematic Review and Meta-Analysis

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Pharmacology

Background:

• Hypercoagulability is a hallmark of COVID-19, potentially worsening outcomes.
• The efficacy and safety of anticoagulation (AC) in hospitalized COVID-19 patients remain debated.
• Existing studies report variable survival benefits associated with AC use.

Purpose of the Study:

• To evaluate the impact of different anticoagulation doses on in-hospital mortality and major bleeding in COVID-19 patients.
• To compare intermediate-to-therapeutic dose AC, prophylactic dose AC, and no AC.
• To synthesize existing evidence through a meta-analysis.

Main Methods:

• Systematic literature search of PubMed, EMBASE, and Cochrane Library databases up to October 22, 2020.
• Inclusion of studies reporting AC use and mortality in COVID-19 patients.
• Meta-analysis of pooled odds ratios (ORs) with 95% confidence intervals (CIs) using random-effects models, excluding studies with high risk of bias.

Main Results:

• Seventeen studies (N=17,833) were included in the meta-analysis, with an overall mortality rate of 23.1%.
• Anticoagulation showed similar mortality to no AC overall, but prophylactic dose AC was associated with lower mortality (OR 0.83; 95% CI 0.73-0.95).
• Intermediate-to-therapeutic AC doses significantly increased mortality (OR 1.60; 95% CI 1.11-2.31) and major bleeding (OR 3.33; 95% CI 2.34-4.72) compared to prophylactic doses.

Conclusions:

• Prophylactic dose anticoagulation appears to offer optimal efficacy and safety for hospitalized COVID-19 patients.
• Higher intensity anticoagulation (intermediate-to-therapeutic) is associated with increased risks of mortality and major bleeding.
• These findings underscore the importance of dose selection for anticoagulation in managing COVID-19.