REVIEW   

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

DOI: 10.23736/S2724-5683.22.06230-5

Copyright © 2022 EDIZIONI MINERVA MEDICA

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 Y. 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 31^st 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