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Efficacy of different anticoagulant doses for patients with COVID-19: a systematic review and network meta-analysis

Hideto Yasuda1,2, Takuya Mayumi3, Hiromu Okano4

  • 1Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Oomiya-ku, Saitama-shi, Saitama, 330-8503, Japan. yasudahideto@me.com.

Infection
|March 31, 2022
PubMed

Insights

For moderate COVID-19, both prophylactic and treatment doses of anticoagulants reduced mortality compared to no treatment. The treatment dose showed a slight preference over the prophylactic dose.

Area of Science:

  • Critical care medicine
  • Pharmacology
  • Infectious diseases

Background:

  • Optimal anticoagulant dosing for COVID-19 remains unclear due to limited comparative randomized controlled trials (RCTs).
  • This study addresses the need to compare prophylactic, treatment, and no anticoagulant doses in COVID-19 patients.

Approach:

  • A network meta-analysis (NMA) was conducted, including RCTs and adjusted observational studies of hospitalized COVID-19 patients (age ≥18).
  • The primary outcome assessed was mortality.
  • Eligible trials were sourced from major databases including Cochrane, MEDLINE, and ClinicalTrials.gov.

Key Points:

  • In moderate COVID-19, both prophylactic and treatment anticoagulant doses significantly reduced short-term mortality versus no treatment.
  • The treatment dose demonstrated the highest efficacy in reducing short-term mortality, followed by the prophylactic dose.
  • For severe COVID-19, no significant difference in mortality was found between prophylactic and treatment doses in pairwise comparisons.

Conclusions:

  • Both treatment and prophylactic anticoagulant doses are effective in reducing mortality in moderate COVID-19.
  • The treatment dose is recommended over the prophylactic dose for both moderate and severe COVID-19 patients.
  • Further research may be needed to clarify optimal dosing in severe disease due to limited data.
Abstract

Keywords:
AnticoagulationBleedingCOVID-19MortalityNetwork meta-analysisVTE

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