Key result
Therapeutic anticoagulation linked to ~38% lower mortality vs prophylactic anticoagulation in COVID-19 patients.
Why the study?
Coagulopathy is a severe sequela of COVID-19 associated with poorer outcomes, but the role of therapeutic versus prophylactic anticoagulation has not been definitively established.
Does therapeutic anticoagulation reduce mortality compared to prophylactic anticoagulation in COVID-19 patients?
Meta-Analysis (n=5,541)
Does therapeutic anticoagulation reduce mortality compared to prophylactic anticoagulation in COVID-19 patients?
Hazard Ratio: 0.62 (95% CI 0.54–0.71)
In real-world observational studies, therapeutic anticoagulation is associated with a significant survival benefit over prophylactic anticoagulation in COVID-19 patients, without a statistically significant increase in bleeding.
Optimal anticoagulation dosing in COVID-19 remains unclear; this observational meta-analysis leaves open questions for randomized confirmation.
INTRODUCTION: Coagulopathy, in the form of either venous or arterial thromboembolism, is one of the most severe sequelae of coronavirus disease (COVID-19) and has been associated with poorer outcomes. However, the role of therapeutic anticoagulation (tAC) or prophylactic anticoagulation (pAC) in COVID-19 patients has not been definitely established. Therefore, the aim of this systematic review and meta-analysis was to gather all the available real-world data in the field and to provide a reliable effect size of the effect on mortality of tAC compared to pAC in COVID-19 patients. EVIDENCE ACQUISITION: October, 2021. Randomized controlled trials were excluded. Mortality and bleedings were considered as primary and secondary outcomes, respectively. EVIDENCE SYNTHESIS: 10 RWS and 5541 patients were included in the analysis. Overall, tAC was associated with lower mortality (HR=0.62, 95% CI: 0.54-0.71). There was asymmetry at the funnel plot suggesting publication bias, that was not confirmed at the Egger test (P=0.07). For the secondary endpoint, there was a non-statistically significant tendency for more bleedings in patients treated with tAC compared to pAC (RR=1.75, 95% CI: 0.81-3.81). CONCLUSIONS: Our meta-analysis, based on RWS and adjusted estimates of risk, suggests a survival benefit of tAC over pAC in COVID-19 patients in the real world.
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Vio et al. (2022) conducted a meta-analysis in COVID-19 (n=5,541). Therapeutic anticoagulation vs. Prophylactic anticoagulation was evaluated on Mortality (HR 0.62, 95% CI 0.54-0.71). Therapeutic anticoagulation was associated with lower mortality compared to prophylactic anticoagulation in COVID-19 patients (HR 0.62; 95% CI 0.54-0.71).
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