Pharmacological thromboprophylaxis in hospitalized patients with acute infectious diseases: a meta-analysis

Venous thromboembolism (VTE) may be a significant complication in medical patients, and infectious disease has been highlighted as an additional risk factor. Pharmacological thromboprophylaxis can prevent VTE and is recommended in at-risk populations, but not routinely in patients with infectious diseases.

We conducted a systematic review and meta-analysis of studies on the effectiveness of pharmacological thromboprophylaxis in patients with acute infections, excluding those involving COVID-19. The primary outcome was VTE events. Secondary outcomes were mortality and adverse events related to anticoagulant therapy.

Data from seven studies (four randomized controlled trials and three observational studies) involving 16,994 patients with infectious diseases were analyzed. Pharmacological thromboprophylaxis regimens consisted of unfractionated heparin, low-molecular-weight heparin (enoxaparin or dalteparin), and fondaparinux. The severity of the disease varied from acute infections to sepsis. Six studies reported fewer VTE events with thromboprophylaxis. The meta-analysis yielded a pooled odds ratio of 0.50 [95% CI: 0.37-0.69, I² = 47%]. Three studies reported bleeding or bruising outcomes: one observational study reported significantly more bleeding with thromboprophylaxis, while two randomized trials reported either no significant difference in severe bleeding or in mild bleeding-related adverse events. Two studies assessed mortality, but neither found a statistically significant difference with or without thromboprophylaxis. One study was at high risk of bias, and another was at critical risk of bias.

This analysis quantifies the effect of thromboprophylaxis in patients with acute infectious diseases. Although available results show that thromboprophylaxis is associated with fewer VTE events, limited data, sparse safety and mortality reporting, and heterogeneity among studies preclude reliable risk-benefit evaluation. Further prospective research is warranted.