Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Jan-Dec:27:10760296211008999.
doi: 10.1177/10760296211008999.

Anticoagulation and In-Hospital Mortality From Coronavirus Disease 2019: A Systematic Review and Meta-Analysis

Chatphatai Moonla  1   2 , Darintr Sosothikul  3   4 , Thita Chiasakul  1   2 , Ponlapat Rojnuckarin  1   2 , Noppacharn Uaprasert  1   2
Affiliations
Meta-Analysis

Anticoagulation and In-Hospital Mortality From Coronavirus Disease 2019: A Systematic Review and Meta-Analysis

Chatphatai Moonla et al. Clin Appl Thromb Hemost. 2021 Jan-Dec.

Abstract

Hypercoagulability in coronavirus disease 2019 (COVID-19) may aggravate disease severity during hospitalization but the reported survival benefits from anticoagulation (AC) vary among studies. We performed a literature research to estimate pooled odds ratios (ORs) of in-hospital mortality and major bleeding comparing among intermediate-to-therapeutic dose AC, prophylactic dose AC, and no AC. Until October 22, 2020, PubMed, EMBASE, and Cochrane Library Database were searched for studies reporting AC utilization and mortality in COVID-19. Studies with suspected risk of bias were excluded before the synthesis of pooled ORs with 95% confidence intervals (CIs) using random-effects models. Of 37 identified studies (N = 19,510), 17 (N = 17,833) were aggregated in the meta-analysis. The overall mortality rate was 23.1% (95% CI 18.7-28.2). The pooled odds of mortality comparing anticoagulated to non-anticoagulated patients were similar, but lower in prophylactic dose AC group (OR 0.83; 95% CI 0.73-0.95). Notably, intermediate-to-therapeutic dose AC increased mortality (OR 1.60; 95% CI 1.11-2.31) and major bleeding compared to prophylactic dose AC (OR 3.33; 95% CI 2.34-4.72). Our findings support the optimal efficacy and safety profiles of prophylactic dose AC in hospitalized COVID-19 patients.

Keywords: COVID-19; SARS-CoV-2; anticoagulation; meta-analysis; mortality.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram for study selection. Abbreviation: AC, anticoagulation.
Figure 2.
Figure 2.
Pooled odds of mortality among hospitalized COVID-19 patients with anticoagulation compared to patients without anticoagulation: (A) any anticoagulation, (B) prophylactic dose anticoagulation, and (C) intermediate-to-therapeutic dose anticoagulation. Abbreviation: df, degree of freedom.
Figure 3.
Figure 3.
Pooled odds of mortality among hospitalized COVID-19 patients with intermediate-to-therapeutic dose anticoagulation compared to patients with prophylactic dose anticoagulation. Abbreviation: df, degree of freedom.
Figure 4.
Figure 4.
Pooled odds of major bleeding among hospitalized COVID-19 patients with intermediate-to-therapeutic dose anticoagulation compared to patients with prophylactic dose anticoagulation. Abbreviation: df, degree of freedom.
See this image and copyright information in PMC

Comment in

References

    1. Noor FM, Islam MM. Prevalence and associated risk factors of mortality among COVID-19 patients: a meta-analysis. J Community Health. 2020;45(6):1270–1282. - PMC - PubMed
    1. Ackermann M, Verleden SE, Kuehnel M, et al. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in COVID-19. N Engl J Med. 2020;383(2):120–128. - PMC - PubMed
    1. Goshua G, Pine AB, Meizlish ML, et al. Endotheliopathy in COVID-19-associated coagulopathy: evidence from a single-centre, cross-sectional study. Lancet Haematol. 2020;7(8):e575–e582. - PMC - PubMed
    1. McGonagle D, O’Donnell JS, Sharif K, Emery P, Bridgewood C. Immune mechanisms of pulmonary intravascular coagulopathy in COVID-19 pneumonia. Lancet Rheumatol. 2020;2(7):e437–e445. - PMC - PubMed
    1. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844–847. - PMC - PubMed