Low Molecular Weight Heparin in Adults Inpatient COVID-19

González‐Porras, José Ramón; Belhassen‐García, Moncef; López-Bernús, Amparo; Vaquero‐Roncero, Luis Mario; Rodriguez, Beatriz; Carbonell, Cristina; Azibeiro, Raúl; Hernández-Sánchez, Alberto; Martín-González, José Ignacio; Manrique, Juan Miguel; Alonso-Claudio, Gloria; Alvárez-Navia, Felipe; Madruga-Martin, Jose Ignacio; Macias-Casanova, Ronald Paul; GarcÃ­a-Criado, Jorge; Lozano, Francisco; Moyano, Jose Carlos; Sánchez-Hernández, Miguel Vicente; Sagredo-Meneses, VÃ­ctor; Rafael, Bastida; Maria, HernÃ¡ndez-PÃ©rez Jose; Chamorro, Antonio-Javier; Marcos, Miguel; Martín-Oterino, José Ángel

doi:10.2139/ssrn.3586665

Cited by 7 publications

(25 citation statements)

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“…Current studies observed elevated D-dimer levels in patients with COVID-19, ranging from a 2.5-fold to a 6.0-fold increase, with these increased levels predicting mortality and the development of thromboembolic events in patients. 22–24 29 30 48 Yet, there is no consensus on a specific cut-off level which can accurately predict disease course, mortality or response to antithrombotic therapy. Mouhat et al suggested the use of 2590 ng/mL as threshold level which corresponds to a ≈5-fold increase in normal D-dimer level.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, examining the role of antiplatelets alone or the combination of anticoagulant and antiplatelet therapies in these patients is highly needed, especially since COVID-19 hypercoagulability is a result of endothelial dysfunction in addition to the activation of the coagulation cascade. 22 76–80 To add, the optimal duration for anticoagulation should be determined, especially since COVID-19 has been associated with thrombotic events even after recovery. 84 85 Furthermore, the ideal anticoagulation dosage is a matter of huge debate and is yet to be determined by well-conducted studies.…”

Section: Discussionmentioning

confidence: 99%

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Role of combining anticoagulant and antiplatelet agents in COVID-19 treatment: a rapid review

et al. 2021

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Although primarily affecting the respiratory system, COVID-19 causes multiple organ damage. One of its grave consequences is a prothrombotic state that manifests as thrombotic, microthrombotic and thromboembolic events. Therefore, understanding the effect of antiplatelet and anticoagulation therapy in the context of COVID-19 treatment is important. The aim of this rapid review was to highlight the role of thrombosis in COVID-19 and to provide new insights on the use of antithrombotic therapy in its management. A rapid systematic review was performed using preferred reporting items for systematic reviews. Papers published in English on antithrombotic agent use and COVID-19 complications were eligible. Results showed that the use of anticoagulants increased survival and reduced thromboembolic events in patients. However, despite the use of anticoagulants, patients still suffered thrombotic events likely due to heparin resistance. Data on antiplatelet use in combination with anticoagulants in the setting of COVID-19 are quite scarce. Current side effects of anticoagulation therapy emphasise the need to update treatment guidelines. In this rapid review, we address a possible modulatory role of antiplatelet and anticoagulant combination against COVID-19 pathogenesis. This combination may be an effective form of adjuvant therapy against COVID-19 infection. However, further studies are needed to elucidate potential risks and benefits associated with this combination.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Role of combining anticoagulant and antiplatelet agents in COVID-19 treatment: a rapid review

et al. 2021

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“…27,29 Gonzalez, Bousquet and Ayrebe reported a beneficial effect for AC on mortality in Covid-19 patients. [40][41][42] Several studies also reported a favourable effect for in-hospital AC on mortality, 39,41,42 and others reported such beneficial effect in only selected subgroups of patients such as mechanically ventilated patients. 31 The current meta-analysis showed a favourable effect for inhospital AC on mortality in Covid-19 patients, and the association persisted when non-adjusted estimates were used.…”

Section: Discussionmentioning

confidence: 97%

“…Three studies (n ¼ 869) provided the adjusted estimates for mortality in patients who received low and high doses of anticoagulants 41,42,44 while four studies 41,42,44,45 provided unadjusted estimates (n ¼ 895).…”

Section: Association Between the Dose Of The Used Anticoagulant And Both Mortality And Incidence Of Vtementioning

confidence: 99%

Anticoagulation outcomes in hospitalized Covid‐19 patients: A systematic review and meta‐analysis of case‐control and cohort studies

Kamel

Sobhy

Magdy

et al. 2020

Reviews in Medical Virology

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Background: Coagulopathy and thromboembolic events are common in patients and are poor prognostic factors. Controversy exists regarding the potential of anticoagulation (AC) to reduce mortality and incidence of thromboembolic events in Covid-19 patients. The current systematic review and meta-analysis investigated the association between anticoagulants and mortality in adult hospitalized COVID-19 patients using the available published non-randomized studies. Methods: Google Scholar, PubMed, Scopus, the Cochrane Library and Clinical Trials.gov were searched for relevant studies. A meta-analysis of adjusted and unadjusted estimates was performed. The relative risk was used as a measure of effect. The random-effects model was used to pool estimates using the generic inverse variance method.Results: Sixteen studies were included in the quantitative data synthesis. Results showed a statistically significant association between AC and mortality (RR ¼ 0.56, 95% CI 0.36; 0.92, p ¼ 0.02). Both therapeutic (Relative risk [RR] ¼ 0.4, 95% CI 0.27; 0.57) and prophylactic AC (RR ¼ 0.54, 95% CI 0.41; 0.71) were associated with lower risk of mortality. Pre-admission AC was not associated with mortality (RR ¼ 0.84, 95% CI 0.49; 1.43, p > 0.05) while prophylactic AC was associated with higher risk of mortality compared to therapeutic AC (RR ¼ 1.58, 95% CI 1.34; 1.87, p < 0.001). Conclusion: Findings support the association of AC with mortality in Covid-19 patients. The results, synthesized from mostly low-quality studies, show that prophylactic and therapeutic AC might reduce mortality in Covid-19 patients.Findings suggest that therapeutic doses might be associated with better survival compared to prophylactic doses.

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“…On the contrary, Gonzalez-Porras et al and Martinelli et al demonstrated that the benefit of the administration of LMWH on in-hospital mortality was higher for the groups receiving the higher doses. 34,46 The study by Nadkarni et al reported a not statistically significant reduction of in-hospital mortality risk, when therapeutic anticoagulant treatment was associated with the prophylactic regimen (HR: 0.86, 95% CI: 0.73-1.02; ►Table 2). 37 Finally, Bolzetta et al indicated that in a cohort of elderly affected by COVID-19, there was no justification for using therapeutic instead of prophylactic doses, having a similar impact on in-hospital mortality risk (HR: 0.89, 95% CI: 0.30-2.71) (►Table 2).…”

mentioning

confidence: 98%

Different Anticoagulant Regimens, Mortality, and Bleeding in Hospitalized Patients with COVID-19: A Systematic Review and an Updated Meta-Analysis

Parisi

Costanzo

Castelnuovo

et al. 2021

Semin Thromb Hemost

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We conducted a systematic review and a meta-analysis to assess the association of anticoagulants and their dosage with in-hospital all-cause mortality in COVID-19 patients. Articles were retrieved until January 8, 2021, by searching in seven electronic databases. The main outcome was all-cause mortality occurred during hospitalization. Data were combined using the general variance-based method on the effect estimate for each study. Separate meta-analyses according to type of COVID-19 patients (hospitalized or intensive care unit [ICU] patients), anticoagulants (mainly heparin), and regimens (therapeutic or prophylactic) were conducted. A total of 29 articles were selected, but 23 retrospective studies were eligible for quantitative meta-analyses. No clinical trial was retrieved. The majority of studies were of good quality; however, 34% did not distinguish heparin from other anticoagulants. Meta-analysis on 25,719 hospitalized COVID-19 patients showed that anticoagulant use was associated with 50% reduced in-hospital mortality risk (pooled risk ratio [RR]: 0.50, 95% confidence interval [CI]: 0.40–0.62; I 2: 87%). Both anticoagulant regimens (therapeutic and prophylactic) reduced in-hospital all-cause mortality, compared with no anticoagulation. Particularly in ICU patients, the anticoagulant therapeutic regimen was associated with a reduced in-hospital mortality risk (RR: 0.30, 95% CI: 0.15–0.60; I 2: 58%) compared with the prophylactic one. However, the former was also associated with a higher risk of bleeding (RR: 2.53, 95% CI: 1.60–4.00; I 2: 65%). Anticoagulant use, mainly heparin, reduced all-cause mortality in COVID-19 patients during hospitalization. Due to the higher risk of bleeding at therapeutic doses, the use of prophylactic dosages of anticoagulant is probably to be preferred in noncritically ill COVID-19 patients.

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Low Molecular Weight Heparin in Adults Inpatient COVID-19

Cited by 7 publications

References 0 publications

Role of combining anticoagulant and antiplatelet agents in COVID-19 treatment: a rapid review

Role of combining anticoagulant and antiplatelet agents in COVID-19 treatment: a rapid review

Anticoagulation outcomes in hospitalized Covid‐19 patients: A systematic review and meta‐analysis of case‐control and cohort studies

Different Anticoagulant Regimens, Mortality, and Bleeding in Hospitalized Patients with COVID-19: A Systematic Review and an Updated Meta-Analysis

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