Therapeutic anticoagulation therapy, compared with prophylactic anticoagulation therapy, significantly increases risk for major bleeding in patients hospitalized with COVID-19, but is more effective in prevention of thromboembolic events. These findings were published in The Clinical Respiratory Journal.
Investigators sought to compare efficacy and safety outcomes of therapeutic and prophylactic doses of anticoagulation therapy among patients hospitalized with COVID-19.
They conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) in COCHRANE, EMBASE, PubMed, and Google Scholar databases from 2019 to 2021 without language restriction. They included 3 studies (screened by 2 independent reviewers) comparing the efficacy and safety of therapeutic dose (n=854) vs prophylactic dose (n=878) anticoagulation therapy among patients hospitalized with COVID-19 (N=1732). Studies that were not RCTs were excluded. Each of the 3 studies had a majority of male patients.
There was a lower incidence of thromboembolic events in therapeutic anticoagulation (63 of 850 patients) vs prophylactic anticoagulation (94 of 873 patients) among patients hospitalized with COVID-19 (relative risk [RR], 1.45; 95% CI, 1.07-1.97; I2=0.0%). Additionally, there was lower incidence of major bleeding in prophylactic anticoagulation (20 of 876 patients) vs therapeutic anticoagulation (46 of 849 patients; RR, 0.42; 95% CI, 0.19-0.93; I2=0.0%).
Some limitations of the study include the small number of RCTs included and that 1 of the trials is underpowered. Also, the heterogeneity of bleeding results is high and the exact dosing of therapeutic and prophylactic anticoagulation is not noted in the 3 included RCTs.
“…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,” the study authors wrote.
Rauniyar R, Kuikel S, Mishra A, et al. 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. Clin Respir J. Published online December 26, 2022. doi:10.1111/crj.13568