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Minerva Cardiology and Angiology 2022 December;70(6):652-62

DOI: 10.23736/S2724-5683.22.06230-5


language: English

Therapeutic vs. prophylactic anticoagulation in COVID-19 patients: a systematic review and meta-analysis of real-world studies

Riccardo VIO 1 , Andrea S. GIORDANI 2, Maria STEFIL 3, Ahmed ALTURKI 4, Vincenzo RUSSO 5, Paolo CHINA 1, Alessio GASPERETTI 6, 7, Marco SCHIAVONE 6, Viktor ČULIĆ 8, 9, Giuseppe BIONDI-ZOCCAI 10, 11, Sakis THEMISTOCLAKIS 1, Gregory YH LIP 3, Riccardo PROIETTI 3

1 Department of Cardiothoracic, Vascular Medicine and Intensive Care, Dell’Angelo Hospital, Mestre, Venice, Italy; 2 Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy; 3 Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK; 4 Division of Cardiology, McGill University Health Center, Montreal, Canada; 5 Department of Medical Translational Sciences, Monaldi Hospital, Luigi Vanvitelli University of Campania, Naples, Italy; 6 Unit of Cardiology, ASST Fatebenefratelli Sacco-Luigi Sacco University Hospital, Milan, Italy; 7 Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 8 School of Medicine, University of Split, Split, Croatia; 9 Department of Cardiology and Angiology, University Hospital Centre Split, Split, Croatia; 10 Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy; 11 Mediterranea Cardiocentro, Naples, Italy

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: Real-world studies (RWS) were identified by searching electronic databases from inception to 31st 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.

KEY WORDS: COVID-19; SARS-CoV-2; Anticoagulants; Hemorrhage

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