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Review
. 2023 Mar 13;12(6):2222.
doi: 10.3390/jcm12062222.

Safety and Efficacy of Different Anticoagulant Doses for Patients with COVID-19 in the ICU: A Systematic Review and Meta-Analysis

Svetlana Rachina  1 , Yuliya Belkova  2 , Anastasia Shchendrygina  1 , Aleksandr Suvorov  3 , Denis Bourgeois  4 , Marina Karuk  5 , Violetta Sitnikova  1 , Nikita Dyatlov  1
Affiliations
Review

Safety and Efficacy of Different Anticoagulant Doses for Patients with COVID-19 in the ICU: A Systematic Review and Meta-Analysis

Svetlana Rachina et al. J Clin Med. .

Abstract

Critically ill COVID-19 patients have a high incidence of thromboembolic events, which significantly influence the risk of mortality. Anticoagulant therapy is generally recommended to these patients but the optimal dosing regimens require further investigations. The objective of this systematic review and meta-analysis was to assess the efficacy and safety of prophylactic, intermediate and therapeutic dose anticoagulation in COVID-19 patients admitted to the ICU. A systematic search for original prospective observational studies and clinical trials was performed in online databases from 2020 to 2022. A total of 13 studies (3239 patients) were included. The type of anticoagulant dosing showed no significant influence on short-term mortality (p = 0.84), deep vein thrombosis (p = 0.66), arterial thrombosis (p = 0.44), major bleeding (p = 0.35) and minor bleeding incidence (p = 0.46). An anticoagulation regimen significantly influenced pulmonary embolism occurrence (16% for prophylactic dose vs. 4% for therapeutic dose, p = 0.02), but the number of studies in the analysis was relatively low. In conclusion, the results of this meta-analysis suggest that critically ill COVID-19 patients admitted in the ICU have no benefit from therapeutic doses of anticoagulants and that all three thromboprophylaxis regimes have a comparable effect on short term mortality and venous thromboembolism incidence but for pulmonary embolism, for which the results were inconclusive.

Keywords: COVID-19; ICU; anticoagulant; deep vein thrombosis; heparin; pulmonary embolism; thromboprophylaxis; venous thromboembolism.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Preferred reporting items for systematic review and meta-analyses (PRISMA) flow diagram of literature screening.
Figure 2
Figure 2
Forest plot of anticoagulation doses influence on short-term mortality in COVID-19 patients in the ICU [10,34,35,36,37,39,40,41,42,43].
Figure 3
Figure 3
Forest plot of anticoagulation doses influence on DVT incidence in COVID-19 patients in the ICU [10,34,35,36,37,39,40,42,43,44,45].
Figure 4
Figure 4
Forest plot of anticoagulation doses influence on PE incidence in COVID-19 patients in the ICU [10,35,39,44].
Figure 5
Figure 5
Forest plot of anticoagulation doses influence on AT incidence in COVID-19 patients in the ICU [10,35,37,39,44].
Figure 6
Figure 6
Forest plot of anticoagulation doses influence on major bleeding incidence in COVID-19 patients in the ICU [34,35,36,37,38,41,42,44].
Figure 7
Figure 7
Forest plot of anticoagulation doses influence on minor bleeding incidence in COVID-19 patients in the ICU [35,36,37,42,44].
See this image and copyright information in PMC

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