Safety and efficacy of prophylactic anticoagulation versus therapeutic anticoagulation in hospital‐admitted COVID‐19 patients: A systematic review and meta‐analysis of randomized controlled trials
Abstract Background COVID‐19 disease‐related coagulopathy and thromboembolic complication, an important aspect of the disease pathophysiology, are frequent and associated with poor outcomes, particularly significant in hospitalized patients. Undoubtedly, anticoagulation forms a cornerstone for the m...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-02-01
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| Series: | The Clinical Respiratory Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/crj.13568 |
| _version_ | 1797935990766043136 |
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| author | Robin Rauniyar Sandip Kuikel Aman Mishra Rohit Rauniyar Shikha Yadav Sahil Thapaliya Amit Sharma Nepal Rahul Rauniyar |
| author_facet | Robin Rauniyar Sandip Kuikel Aman Mishra Rohit Rauniyar Shikha Yadav Sahil Thapaliya Amit Sharma Nepal Rahul Rauniyar |
| author_sort | Robin Rauniyar |
| collection | DOAJ |
| description | Abstract Background COVID‐19 disease‐related coagulopathy and thromboembolic complication, an important aspect of the disease pathophysiology, are frequent and associated with poor outcomes, particularly significant in hospitalized patients. Undoubtedly, anticoagulation forms a cornerstone for the management of hospitalized COVID‐19 patients, but the appropriate dosing has been inconclusive and a subject of research. We aim to review existing literature and compare safety and efficacy outcomes of prophylactic and therapeutic dose anticoagulation in such patients. Methods We did a systematic review and meta‐analysis to compare the efficacy and safety of prophylactic dose anticoagulation when compared with therapeutic dosing in hospitalized COVID‐19 patients. We searched PubMed, Google Scholar, EMBASE and COCHRANE databases from 2019 to 2021, without any restriction by language. We screened records, extracted data and assessed the risk of bias in the studies. RCTs that directly compare therapeutic and prophylactic anticoagulants dosing and are not placebo‐controlled trials were included. Analyses of data were conducted using the Mantel–Haenszel random‐effects model (DerSimonian–Laird analysis). The study is registered with PROSPERO (CRD42021265948). Results We included three studies in the final quantitative analysis. The incidence of thromboembolic events in therapeutic anticoagulation was lower in comparison with prophylactic anticoagulation in hospitalized COVID‐19 patients and reached statistical significance [RR 1·45, 95% CI (1.07, 1.97) I2 –0%], whereas major bleeding as an adverse event was found lower in prophylactic anticoagulation in comparison with therapeutic anticoagulation that was statistically significant [RR 0·42, 95% CI(0.19, 0.93) I2 –0%]. Conclusion Our study shows that therapeutic dose anticoagulation is more effective in preventing thromboembolic events than prophylactic dose but significantly increases the risk of major bleeding as an adverse event. So, the risk–benefit ratio must be considered while using either of them. |
| first_indexed | 2024-04-10T18:23:46Z |
| format | Article |
| id | doaj.art-ba403e002b434e928499f9901471a7df |
| institution | Directory Open Access Journal |
| issn | 1752-6981 1752-699X |
| language | English |
| last_indexed | 2024-04-10T18:23:46Z |
| publishDate | 2023-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | The Clinical Respiratory Journal |
| spelling | doaj.art-ba403e002b434e928499f9901471a7df2023-02-02T06:54:35ZengWileyThe Clinical Respiratory Journal1752-69811752-699X2023-02-01172737910.1111/crj.13568Safety and efficacy of prophylactic anticoagulation versus therapeutic anticoagulation in hospital‐admitted COVID‐19 patients: A systematic review and meta‐analysis of randomized controlled trialsRobin Rauniyar0Sandip Kuikel1Aman Mishra2Rohit Rauniyar3Shikha Yadav4Sahil Thapaliya5Amit Sharma Nepal6Rahul Rauniyar7Maharajgunj Medical Campus Tribhuvan University Institute of Medicine Kathmandu NepalMaharajgunj Medical Campus Tribhuvan University Institute of Medicine Kathmandu NepalMaharajgunj Medical Campus Tribhuvan University Institute of Medicine Kathmandu NepalInternal Medicine McLaren Flint/Michigan State University (MSU) Flint Michigan USANepalgunj Medical College Kathmandu University Kathmandu NepalMaharajgunj Medical Campus Tribhuvan University Institute of Medicine Kathmandu NepalMaharajgunj Medical Campus Tribhuvan University Institute of Medicine Kathmandu NepalInternal Medicine, The Wright Center for Graduate Medical Education Scranton Pennsylvania USAAbstract Background COVID‐19 disease‐related coagulopathy and thromboembolic complication, an important aspect of the disease pathophysiology, are frequent and associated with poor outcomes, particularly significant in hospitalized patients. Undoubtedly, anticoagulation forms a cornerstone for the management of hospitalized COVID‐19 patients, but the appropriate dosing has been inconclusive and a subject of research. We aim to review existing literature and compare safety and efficacy outcomes of prophylactic and therapeutic dose anticoagulation in such patients. Methods We did a systematic review and meta‐analysis to compare the efficacy and safety of prophylactic dose anticoagulation when compared with therapeutic dosing in hospitalized COVID‐19 patients. We searched PubMed, Google Scholar, EMBASE and COCHRANE databases from 2019 to 2021, without any restriction by language. We screened records, extracted data and assessed the risk of bias in the studies. RCTs that directly compare therapeutic and prophylactic anticoagulants dosing and are not placebo‐controlled trials were included. Analyses of data were conducted using the Mantel–Haenszel random‐effects model (DerSimonian–Laird analysis). The study is registered with PROSPERO (CRD42021265948). Results We included three studies in the final quantitative analysis. The incidence of thromboembolic events in therapeutic anticoagulation was lower in comparison with prophylactic anticoagulation in hospitalized COVID‐19 patients and reached statistical significance [RR 1·45, 95% CI (1.07, 1.97) I2 –0%], whereas major bleeding as an adverse event was found lower in prophylactic anticoagulation in comparison with therapeutic anticoagulation that was statistically significant [RR 0·42, 95% CI(0.19, 0.93) I2 –0%]. Conclusion Our study shows that therapeutic dose anticoagulation is more effective in preventing thromboembolic events than prophylactic dose but significantly increases the risk of major bleeding as an adverse event. So, the risk–benefit ratio must be considered while using either of them.https://doi.org/10.1111/crj.13568anticoagulation in COVID‐19COVID‐19prophylactic anticoagulationSARS‐CoV‐2therapeutic anticoagulation |
| spellingShingle | Robin Rauniyar Sandip Kuikel Aman Mishra Rohit Rauniyar Shikha Yadav Sahil Thapaliya Amit Sharma Nepal Rahul Rauniyar Safety and efficacy of prophylactic anticoagulation versus therapeutic anticoagulation in hospital‐admitted COVID‐19 patients: A systematic review and meta‐analysis of randomized controlled trials The Clinical Respiratory Journal anticoagulation in COVID‐19 COVID‐19 prophylactic anticoagulation SARS‐CoV‐2 therapeutic anticoagulation |
| title | Safety and efficacy of prophylactic anticoagulation versus therapeutic anticoagulation in hospital‐admitted COVID‐19 patients: A systematic review and meta‐analysis of randomized controlled trials |
| title_full | Safety and efficacy of prophylactic anticoagulation versus therapeutic anticoagulation in hospital‐admitted COVID‐19 patients: A systematic review and meta‐analysis of randomized controlled trials |
| title_fullStr | Safety and efficacy of prophylactic anticoagulation versus therapeutic anticoagulation in hospital‐admitted COVID‐19 patients: A systematic review and meta‐analysis of randomized controlled trials |
| title_full_unstemmed | Safety and efficacy of prophylactic anticoagulation versus therapeutic anticoagulation in hospital‐admitted COVID‐19 patients: A systematic review and meta‐analysis of randomized controlled trials |
| title_short | Safety and efficacy of prophylactic anticoagulation versus therapeutic anticoagulation in hospital‐admitted COVID‐19 patients: A systematic review and meta‐analysis of randomized controlled trials |
| title_sort | safety and efficacy of prophylactic anticoagulation versus therapeutic anticoagulation in hospital admitted covid 19 patients a systematic review and meta analysis of randomized controlled trials |
| topic | anticoagulation in COVID‐19 COVID‐19 prophylactic anticoagulation SARS‐CoV‐2 therapeutic anticoagulation |
| url | https://doi.org/10.1111/crj.13568 |
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