Clinical Outcomes of Anticoagulant Therapy in COVID-19 Patients with Pre-Existing Cardiovascular Diseases: A Systematic Review

Abstract

The COVID-19 infection caused by SARS-CoV-2 is a healthcare crisis that has led to unparalleled disruption and has impacted healthcare services, leading to significant morbidity and mortality in the worldwide population. Insufficient data on the management of COVID-19 complications such as hypercoagulability and the controversy about the benefits of anticoagulant therapy are major challenges encountered by clinicians, especially for patients with pre-existing cardiovascular diseases (CVD), and are still debatable. Therefore, we endeavored to conduct a systematic review to assess the clinical outcomes of prior anticoagulant therapy in patients with COVID-19 having pre-existing CVD. Electronic searches of the PubMed database and EBSCO Information Services were carried out, and all relevant articles were employed. Seven articles with data from 21,989 subjects were included. Despite the promised clinical outcomes of anticoagulant therapy, the results of the current systematic review indicated insignificant improvements in the reduction of mortality rate or ICU admission among patients with COVID-19 having pre-existing CVD. Furthermore, direct oral anticoagulant (DOAC) were favored over vitamin K antagonists (VKAs) due to better action and less side effects. In conclusion, the findings are controversial as we did not statistically analyze the results. The data showed inconsistent information with no clear effect of anticoagulant use before patient hospitalization or decreasing COVID-19 severity, particularly in those with CVD. Further studies including randomized controlled trials are required to describe the best course as well as optimal dose of anticoagulant use in the treatment of patients with COVID-19, particularly those with comorbidities such as CVD.

The impacts of prophylactic anticoagulation therapy during hospitalization on long-term cardiovascular outcomes in high-risk COVID-19 patients amid the omicron wave of the pandemic

“…Thus, anticoagulants have been primarily ordered for severe COVID-19 patient treatment. However, information on the prognosis of COVID-19 patients with concomitant CV disease regularly using anticoagulants is still debatable, and more evidence are needed to investigate the valuable outcomes of the use of anticoagulants in these patients [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] . The association of systemic anticoagulation with extended survival of hospitalized patients with COVID-19 demonstrated no statistical significance according to a previous cohort study.…”

“…And we found that prophylactic anticoagulation therapy during hospitalization in this population was effective for the prevention from MACEs during the long-term follow-up after discharge. If anticoagulants are to be used, DOACs are favored due to their better action and lesser side effects compared with other anticoagulant agents such as VKAs [15] . Further research is required to describe the best course and optimal dose of anticoagulant use in the treatment of patients with COVID-19 with comorbidities such as CV disease.…”

“…COVID-19 patients with CV disease tend to evolve into critical condition or have a poor prognosis. And information on the prognosis of patients with concomitant CV disease regularly using anticoagulants before being presented to the clinics complaining of COVID-19 symptoms is also debatable [15] , and more evidence are required to investigate the valuable outcomes of the use of anticoagulants in this population, especially amid the omicron wave of the pandemic.…”