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Anticoagulant Treatment Regimens in Patients With Covid-19: A Meta-Analysis

Anselm Jorda1, Jolanta M Siller-Matula2,3, Markus Zeitlinger1

  • 1Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.

Clinical Pharmacology and Therapeutics
|December 4, 2021
PubMed

Insights

Higher-dose anticoagulation for COVID-19 did not reduce mortality compared to prophylactic doses. While it decreased thromboembolic events, it increased major bleeding risks, showing no survival benefit for routine use.

Area of Science:

  • Medical Research
  • Clinical Trials
  • Pharmacology

Background:

  • Coronavirus disease 2019 (COVID-19) is linked to a hypercoagulable state.
  • Hypotheses suggest higher-dose anticoagulation may be more effective than prophylactic doses for COVID-19 treatment.

Purpose of the Study:

  • To evaluate the efficacy and safety of higher-dose anticoagulation versus prophylactic-dose anticoagulation in COVID-19 patients.
  • To compare risks of death, thromboembolic events, and major bleeding between different anticoagulation strategies.

Main Methods:

  • Meta-analysis of ten randomized controlled open-label trials.
  • Inclusion of 5,753 patients diagnosed with COVID-19.
  • Comparison of higher-dose (therapeutic and intermediate) versus prophylactic-dose anticoagulation.

Main Results:

  • No significant difference in the risk of death or net adverse clinical events between higher-dose and prophylactic anticoagulation.
  • Higher-dose anticoagulation reduced thromboembolic events but significantly increased major bleeding risk.
  • No survival benefit observed for higher-dose anticoagulation in critically ill, noncritically ill, or patients with elevated d-dimer levels.

Conclusions:

  • Current evidence does not support the routine use of higher-dose anticoagulation (therapeutic or intermediate) in COVID-19 patients.
  • The increased risk of major bleeding outweighs the benefits of reduced thromboembolic events without a clear survival advantage.
  • Further research may be needed to identify specific patient subgroups who could benefit from higher-dose anticoagulation.

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