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Use of anticoagulants in patients with COVID-19: a living systematic review and meta-analysis

Diane R Batista1, Idevaldo Floriano2, Antonio Silvinato3

  • 1. Divisão de Pneumologia, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu (SP) Brasil.

Jornal Brasileiro De Pneumologia : Publicacao Oficial Da Sociedade Brasileira De Pneumologia E Tisilogia
|June 8, 2022
PubMed

Insights

Anticoagulants did not significantly impact outcomes for non-hospitalized COVID-19 patients. For hospitalized patients, anticoagulation slightly reduced thrombotic events but did not affect mortality, with moderate evidence quality.

Area of Science:

  • Medical research
  • Pharmacology
  • Infectious diseases

Background:

  • COVID-19 is associated with an increased risk of venous thromboembolism.
  • The role of anticoagulants in managing COVID-19 remains a critical area of investigation.

Purpose of the Study:

  • To systematically review and analyze the efficacy and safety of anticoagulants in treating COVID-19 patients.
  • To compare anticoagulant use in non-hospitalized versus hospitalized COVID-19 cases.

Main Methods:

  • Systematic review and meta-analysis of Phase 3 randomized controlled trials.
  • Searched MEDLINE, EMBASE, Cochrane, and ClinicalTrials.gov up to January 2022.
  • Assessed risk of bias using Cochrane tool and evidence quality with GRADE.

Main Results:

  • In non-hospitalized patients, no significant difference in venous thromboembolism or bleeding with post-discharge anticoagulation.
  • In hospitalized patients, full anticoagulation showed a slight reduction in thrombotic events (moderate evidence quality).
  • No significant difference in major bleeding risk or mortality with anticoagulation in hospitalized patients.

Conclusions:

  • Therapeutic anticoagulation does not appear to affect COVID-19 patient mortality.
  • A slight reduction in venous thromboembolism is observed in hospitalized COVID-19 patients receiving anticoagulation.
  • Evidence quality for bleeding risk and intermediate-dose prophylaxis is very low.
Abstract

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