Current best evidence for clinical care (more info)
The incidence of venous thromboembolism (VTE) events in patients with COVID-19 treated with a standard thromboprophylaxis dose of anticoagulants remains high. We conducted a systematic review in order to explore the association between therapeutic-dose anticoagulation and its effect on mortality in patients with COVID-19. A systematic search was carried out using the electronic databases of PubMed, EuropePMC, and the Cochrane Central Database, using specific keywords. All articles that fulfilled the inclusion criteria were included in the qualitative analysis. There were 8 observational studies included in the final qualitative analysis. Quality assessment using the Newcastle-Ottawa Scale (NOS) showed a mean score of 7.5 ± 1.06, indicating moderate to high quality of the studies. Three retrospective cohort studies reported a reduction in the mortality rate, while 6 other studies showed no mortality benefits among patients with COVID-19 treated with therapeutic-dose anticoagulation. There was a slight tendency toward a reduction in the mortality rate among mechanically-ventilated patients with COVID-19 receiving therapeutic-dose anticoagulation. Bleeding events and thrombotic complications among patients receiving therapeutic-dose anticoagulation were reported in 3 studies. Although it is too soon to draw any conclusions, this systematic review draws attention to current evidence regarding the association between therapeutic-dose anticoagulation and its effect on mortality in patients with COVID-19.
| Discipline / Specialty Area | Score |
|---|---|
| Infectious Disease | |
| Hospital Doctor/Hospitalists | |
| Internal Medicine | |
| Respirology/Pulmonology | |
| Hemostasis and Thrombosis | |
| Intensivist/Critical Care | |
The data from these observational studies have such a high risk of bias that we really don't know the answer until we have the results of the many RCTs going on.
This is an informative summary of information to date; although, with the rapidly increasing body of literature on this topic, has the unfortunate potential to become outdated quickly.
This article is a meta-analysis of observational studies and thus is prone to the same biases as the original investigations. The question of whether therapeutic AC for COVID-19 disease is beneficial remains an unsettled question.
The question of anticoagulating all patients with COVID-19 has been raised repeatedly. This metanalysis demonstrates that the survival benefit of anticoagulating all patients is no better than when they were not anticoagulated. It did not address whether supratherapeutic doses were needed or beneficial.