Key result
Prophylactic anticoagulation cuts mortality by ~20% versus no anticoagulation in COVID-19 patients.
Why the study?
The study was conducted to inform efforts to treat and control the outbreak with effective anticoagulant treatment strategies for COVID-19 patients.
Does prophylactic or therapeutic anticoagulation reduce mortality or thrombotic events in patients with COVID-19 compared to no anticoagulation?
Meta-Analysis (n=7,681)
Does prophylactic or therapeutic anticoagulation reduce mortality or thrombotic events in patients with COVID-19 compared to no anticoagulation?
Odds Ratio: 0.8 (95% CI 0.69–0.93)
In patients with COVID-19, prophylactic anticoagulation reduces mortality compared to no anticoagulation, while therapeutic anticoagulation reduces deep vein thrombosis but significantly increases bleeding risk compared to prophylactic dosing.
Anticoagulation may lower mortality versus none in COVID-19; leaves open optimal dosing and bleeding trade-offs pending randomized data.
BACKGROUND: To better inform efforts to treat and control the current outbreak with effective anticoagulant treatment strategies for coronavirus disease 2019 patients. METHODS: We searched Cochrane Library, Pubmed, EMBASE, MEDLINE, SCIEXPANDED, Web of Science, Google Scholar, CNKI (Chinese Database), WanFang (Chinese Database), CBM (Chinese Database), VIP (Chinese Database) for studies published from November 1, 2019 to October 1, 2020, and we searched references of identified articles. Studies were reviewed for methodological quality. A random-effects model was used to pool results. Heterogeneity was assessed using I2. Publication bias was assessed using funnel plot. RESULTS: Fourteen studies involving 7681 patients were included. We meta-analyzed the bleeding, deep vein thrombosis, and pulmonary embolism risk between no anticoagulation and prophylactic anticoagulation, and found no significant difference. The same trend occurred in the comparison between with and without anticoagulation. However, when compared with no anticoagulation, both prophylactic anticoagulation (odd ratio [OR] = 0.80, 95% confidence interval [CI]: 0.69-0.93) and therapeutic anticoagulation (OR = 0.91, 95% CI: 0.80-1.05) had lower risk of mortality. Furthermore, the risk of overall bleeding among patients with therapeutic anticoagulation was 3.11 times (95% CI: 2.29-4.24) than that of patients with prophylactic anticoagulation. On the contrary, therapeutic anticoagulation had lower risk of deep vein thrombosis than prophylactic anticoagulation (OR = 0.34, 95% CI: 0.19-0.63). CONCLUSIONS: Among coronavirus disease 2019 patients, preventive and therapeutic anticoagulation were more beneficial than no anticoagulation for reducing mortality rate. The result will inform healthcare providers and public health policy makers in efforts to treat and control the current outbreak.
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A 2021 study conducted a meta-analysis in COVID-19 (n=7,681). Prophylactic anticoagulation vs. No anticoagulation was evaluated on Mortality (OR 0.80, 95% CI 0.69-0.93). Prophylactic anticoagulation significantly reduced the risk of mortality compared to no anticoagulation in patients with COVID-19 (OR 0.80).
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