The effect of higher-intensity-dosing anticoagulation in the clinical outcomes in hospitalized patients with COVID-19: A meta-analysis of randomized controlled trials

Chia Siang Kow, Dinesh Sangarran Ramachandram, Syed Shahzad Hasan

Research output: Contribution to journalArticlepeer-review

Abstract

Objective
We aimed to perform a meta-analysis to summarize the overall evidence from randomized controlled trials related to higher-intensity anticoagulation in hospitalized patients with COVID-19.

Methods
A systematic literature search was performed in electronic databases to identify randomized controlled trials comparing the clinical outcomes between intermediate or therapeutic anticoagulation and prophylactic anticoagulation. Meta-analyses with random-effects models were used to estimate the pooled odds ratio (OR) for outcomes of interest at a 95% confidence interval (CI).

Results
Eight randomized controlled trials were included, with a total of 5405 hospitalized patients with COVID-19. The meta-analysis revealed no statistically significant difference in the odds of mortality (pooled OR = 0.92; 95% CI 0.71–1.19) but a statistically significant reduction in the odds of development of thrombotic events (pooled OR = 0.55; 95% CI 0.42–0.72), and significantly increased odds of development of major bleeding (pooled OR = 1.81; 95% CI 1.20–2.72) with the use of intermediate/therapeutic anticoagulation relative to prophylactic anticoagulation, with adequate evidence against our model hypothesis of “no significant difference”, at the current sample size. Subgroup analysis in patients with a severe course of COVID-19 observed a statistically significant reduction in the odds of development of thrombotic events (pooled OR = 0.66; 95% CI 0.45–0.98) but no significant difference in the odds of development of major bleeding events (pooled OR = 1.37; 95% CI 0.74–2.56), with the use of intermediate/therapeutic anticoagulation relative to prophylactic anticoagulation.

Conclusion
There were net clinical benefits with higher-intensity-dosing anticoagulation relative to prophylactic-dosing anticoagulation among hospitalized patients with severe COVID-19.
Original languageEnglish
JournalJournal of Infection and Chemotherapy
Early online date17 Nov 2021
DOIs
Publication statusE-pub ahead of print - 17 Nov 2021

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