Patell R, Chiasakul T, Bauer E, et al. Pharmacologic Thromboprophylaxis and Thrombosis in Hospitalized Patients with COVID-19: A Pooled Analysis. Thromb Haemost. 2021 Jan;121(1):76-85. doi: 10.1055/s-0040-1721664. Epub 2020 Dec 30. (Systematic review)

BACKGROUND: Coronavirus disease 2019 (COVID-19) increases thrombosis in hospitalized patients prompting adoption of different thromboprophylaxis strategies. Safety and efficacy of escalated-dose pharmacologic thromboprophylaxis are not established.

OBJECTIVES: To determine the pooled incidence of thrombosis/bleeding in hospitalized patients with COVID-19 for standard-dose, intermediate-dose, therapeutic anticoagulation, and no pharmacologic thromboprophylaxis.

METHODS: MEDLINE, EMBASE, and Cochrane CENTRAL were searched up to August 29, 2020 for studies reporting pharmacologic thromboprophylaxis and thrombosis or bleeding. Pooled event rates were calculated using a random-effects model.

RESULTS: Thirty-five observational studies were included. The pooled incidence rates of total venous thromboembolism (N = 4,685) were: no prophylaxis 41.9% (95% confidence interval [CI]: 28.1-57.2, I2 = 76%), standard-dose prophylaxis 19.8% (95% CI: 13.2-28.6, I2 = 95%), intermediate-dose prophylaxis 11.9% (95% CI: 4.3-28.6, I2 = 91%), and therapeutic-dose anticoagulants 10.5% (95% CI: 4.2-23.8, I2 = 82%, p = 0.003). The pooled incidence rates of arterial thrombosis (N = 1,464) were: no prophylaxis 11.3% (95% CI: 5.2-23.0, I2 = 0%), standard-dose prophylaxis 2.5% (95% CI: 1.4-4.3, I2 = 45%), intermediate-dose prophylaxis 2.1% (95% CI: 0.5-7.7, I2 = 45%), and therapeutic-dose anticoagulants 1.3% (95% CI: 0.2-8.8, I2 = 0, p = 0.009). The pooled bleeding event rates (N = 6,393) were nonsignificantly higher in therapeutic-dose anticoagulants compared with standard-dose prophylaxis, (6.3 vs. 1.7%, p = 0.083).

CONCLUSION: Thrombosis rates were lower in hospitalized COVID-19 patients who received pharmacologic thromboprophylaxis. Thrombosis and bleeding rates for patients receiving intermediate-dose thromboprophylaxis or therapeutic anticoagulation were similar to those who received standard-dose pharmacologic thromboprophylaxis.

Discipline Area Score
Physician 5 / 7
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Comments from MORE raters

Physician rater

Confirms that VTE incidence is high when no prophylaxis is given, although assessment of magnitude is limited by the inclusion of asymptomatic events.

Physician rater

Meta-analysis of low-quality trials that provides neither new nor reliable data on COVID-related thromboses.
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