Prophylactic anticoagulants for people hospitalised with COVID-19

Abstract

BackgroundCoronavirus disease 2019 (COVID-19) is a serious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The primary manifestation is respiratory insu iciency that can also be related to di use pulmonary microthrombosis in people with COVID-19. This disease also causes thromboembolic events, such as pulmonary embolism, deep venous thrombosis, arterial thrombosis, catheter thrombosis, and disseminated intravascular coagulopathy. Recent studies have indicated a worse prognosis for people with COVID-19 who developed thromboembolism.Anticoagulants are medications used in the prevention and treatment of venous or arterial thromboembolic events. Several drugs are used in the prophylaxis and treatment of thromboembolic events, such as heparinoids (heparins or pentasaccharides), vitamin K antagonists and direct anticoagulants. Besides their anticoagulant properties, heparinoids have an additional anti-inflammatory potential, that may a ect the clinical evolution of people with COVID-19. Some practical guidelines address the use of anticoagulants for thromboprophylaxis in people with COVID-19, however, the benefit of anticoagulants for people with COVID-19 is still under debate. ObjectivesTo assess the e ects of prophylactic anticoagulants versus active comparator, placebo or no intervention, on mortality and the need for respiratory support in people hospitalised with COVID-19. Search methodsWe searched CENTRAL, MEDLINE, Embase, LILACS and IBECS databases, the Cochrane COVID-19 Study Register and medRxiv preprint database from their inception to 20 June 2020. We also checked reference lists of any relevant systematic reviews identified and contacted specialists in the field for additional references to trials. Selection criteriaRandomised controlled trials (RCTs), quasi-RCTs, cluster-RCTs and cohort studies that compared prophylactic anticoagulants (heparin, vitamin K antagonists, direct anticoagulants, and pentasaccharides) versus active comparator, placebo or no intervention for the management of people hospitalised with COVID-19. We excluded studies without a comparator group. Primary outcomes were all-cause Prophylactic anticoagulants for people hospitalised with COVID-19 (Review)

Use of low-molecular weight heparin, transfusion and mortality in COVID-19 patients not requiring ventilation

“…In our academic hospitals, patients were mostly treated with prophylactic doses of LMWH, whereas intermediate or therapeutic doses were used only in a small group of patients (n = 32, 12.3%). This means that most clinicians strictly adhere to the current international recommendations, based on observational data or information obtained in similar setting of hospitalized patients [ 9 , 10 , 14 , 19 – 21 ].…”

Pharmacologic Thromboprophylaxis and Thrombosis in Hospitalized Patients with COVID-19: A Pooled Analysis

“…The reduction of all-cause mortality with prophylactic anticoagulants compared with no prophylaxis was inconsistent among the included studies and the analyses of VTE events were not performed due to the lack of data. 60 Using a pooled analysis, our study quantifies and compares the estimates of these outcomes according to the dosage of pharmacologic thromboprophylaxis, and therefore, adding value to the existing literature. This pooled analysis suggests that standard pharmacologic thromboprophylaxis is effective in preventing total venous thrombotic events during hospitalization compared with no anticoagulation and supports current societal guidance that recommends at least a universal pharmacologic thromboprophylaxis for all hospitalized patients with COVID-19.…”

“…The reduction of all-cause mortality with prophylactic anticoagulants compared with no prophylaxis was inconsistent among the included studies and the analyses of VTE events were not performed due to the lack of data. 60 Using a pooled analysis, our study quantifies and compares the estimates of these outcomes according to the dosage of pharmacologic thromboprophylaxis, and therefore, adding value to the existing literature.…”

Mild to Severe Neurological Manifestations of COVID-19: Cases Reports

“…It appears that the ischemic stroke was complicated by a hemorrhagic infarction, possibly fostered by the prophylactic use of heparin [ 40 , 41 , 42 ]. Similarly, another study reported a case of fatal intracranial bleeding in a patient affected by COVID-19 who was treated with heparin [ 27 ].…”