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Therapeutic vs. prophylactic anticoagulation in COVID-19 patients: a systematic review and meta-analysis of

Riccardo Vio1, Andrea S Giordani2, Maria Stefil3

  • 1Department of Cardiothoracic, Vascular Medicine and Intensive Care, Dell'Angelo Hospital, Mestre, Venice, Italy - riccardo.vio.1@gmail.com.

Minerva Cardiology and Angiology
|October 28, 2022
PubMed

Insights

Therapeutic anticoagulation (tAC) significantly reduced mortality in COVID-19 patients compared to prophylactic anticoagulation (pAC). This real-world evidence suggests a survival benefit for tAC in managing COVID-19 associated coagulopathy.

Area of Science:

  • Medical research
  • Hematology
  • Infectious diseases

Background:

  • Coagulopathy is a severe complication of COVID-19, impacting patient outcomes.
  • The comparative effectiveness of therapeutic anticoagulation (tAC) versus prophylactic anticoagulation (pAC) in COVID-19 patients remains unclear.
  • This study addresses the need for real-world data on anticoagulation strategies for COVID-19.

Approach:

  • A systematic review and meta-analysis of real-world studies (RWS) was conducted.
  • 10 RWS involving 5541 patients were included, excluding randomized controlled trials.
  • Mortality and bleeding events were analyzed as primary and secondary outcomes, respectively.

Key Points:

  • Therapeutic anticoagulation (tAC) was associated with a significant reduction in mortality among COVID-19 patients (HR=0.62).
  • A non-statistically significant trend towards increased bleeding was observed with tAC compared to pAC (RR=1.75).
  • Publication bias was assessed and not confirmed, strengthening the findings.

Conclusions:

  • Real-world data suggest a survival benefit of therapeutic anticoagulation (tAC) over prophylactic anticoagulation (pAC) in COVID-19 patients.
  • The findings support the use of tAC for managing coagulopathy in COVID-19.
  • Further research may refine risk-benefit assessments for anticoagulation in this population.
Abstract

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