2. Summary of characteristics of included studies.
Study (design) | Country | Participant age (mean ± SD) | Setting | Intervention type (dose) | Comparator | All‐cause mortality | Necessity for additional respiratory support | Follow‐up time (mean days) | Total participants allocated | Intervention group participants (anticoagulant) |
Albani 2020 (Prospective cohort) |
Italy | 68.66 ± 12.62 (experimental), 70.6 ± 15.01 (comparator) | Hospitala | Enoxaparin (40‐80 mg once daily, duration 3‐9 days) | NA | In‐hospital mortality: aOR 0.53 (95% CI 0.10 to 0.70), in favour of intervention group | NR | Until death or hospital discharge (time in days NR) | 1403 | 799 |
Lemos 2020 (RCT) |
Brazil | 55 ± 10 (experimental), 58 ± 16 (comparator) | Hospitala | Therapeutic anticoagulation: heparin (SC enoxaparin, adjusted dose by age and CrCl (maximum dose allowed 140 mg twice daily) | Prophylactic anticoagulation: SC UFH 5000 IU three times/day (if weight < 120 kg) and 7500 IU 3 times/day (if weight > 120 kg) or enoxaparin 40 mg once daily (if weight < 120 kg) and 40 mg twice daily (if weight > 120 kg) according to the doctor's judgment | RR 0.33 (95% CI 0.04 to 2.69) | NR | 28 | 20 | 10 |
Lopes 2021 (RCT) |
Brazil | 56.7 ± 14.1 (experimental), 56.5 ± 14.5 (comparator) | Hospitala | Therapeutic anticoagulation: stable participants = rivaroxaban 20 mg once daily; unstable participants = enoxaparin 1 mg/kg twice daily. Followed by rivaroxaban for 30 days, irrespective of the duration of hospitalisation |
Prophylactic anticoagulation: enoxaparin 40 mg once daily | RR 1.49 (95% CI 0.90 to 2.46) | RR 0.16 (95% CI 0.02 to 1.35) | 30 | 615 | 310 |
Rentsch 2020 (Prospective cohort) |
USA | 67.03 ± 12.31 (experimental), 67.83 ± 13.74 (comparator) | Hospitala |
|
NA | Inpatient mortality: aHR 0.69 (95% CI 0.61 to 0.77) 30‐day mortality: aHR 0.73 (95% CI 0.66 to 0.81) |
NR | 30 | 4297 | 3627 |
Sadeghipour 2021 (RCT) |
Iran | 61.23 ± 14.68 (experimental), 59.66 ± 17.88 (comparator) | Hospitala | Higher‐dose anticoagulation: enoxaparin 1 mg/kg once daily, modified according to body weight and CrCl | Lower‐dose anticoagulation: enoxaparin 40 mg once daily, modified according to body weight and CrCl | Short‐term time point: RR 1.05 (95% CI 0.87 to 1.28) Long‐term time point: RR 1.07 (95% CI 0.89 to 1.29) |
Short‐term time point: no events in both groups Long‐term time point: no events in both groups |
90 | 562 | 276 |
Santoro 2020 (Prospective cohort) |
Spain, Italy, Ecuador, Cuba, Germany, China, Canada, Serbia, USA, Chile, and Colombia | 66 ± 15 (experimental), 63 ± 27 (comparator) | Hospitala | Anticoagulant (oral, SC, or IV):
|
NA | RR 0.91 (95% CI 0.89 to 0.93), in all participants (N = 3089) RR 0.58 (95% CI 0.49 to 0.67), in those non‐anticoagulated before admission (N = 2695) RR 0.50 (95% CI 0.37 to 0.70), in those undergoing invasive ventilation (N = 391) RR 0.72 (95% CI 0.51 to 1.01), in those undergoing non‐invasive ventilation (N = 583) |
NR | 15 | 5838 | 2601 |
Zarychanski 2021 (RCT) |
UK, USA, Canada, Brazil, Ireland, Netherlands, Australia, Nepal, Saudi Arabia, and Mexico | Critically ill: 60.2 ± 13.1 (experimental), 61.6 ± 12.5 (comparator) Moderate‐severity illness: 59.0 ± 14.1 (experimental), 58.8 ± 13.9 (comparator) |
Hospitala | Therapeutic anticoagulation: LMWH or UFH according to local protocols used for the treatment of acute VTE for up to 14 days or until recovery (defined as hospital discharge, or liberation from supplemental oxygen for ≥ 24 h) | Prophylactic anticoagulation: LMWH or UFH according to local practice or with guidance from the trial protocol on maximum dosing, which included either standard low‐dose thromboprophylaxis or enhanced intermediate dose thromboprophylaxis | Short‐term time point: moderate‐severity RR 0.89 (95% CI 0.67 to 1.19), critically ill RR 1.03 (95% CI 0.88 to 1.21) Long‐term time point: NR |
Short‐term time point: moderate‐severity RR 0.89 (95% CI 0.74 to 1.08), critically ill: NR Long‐term time point: NR |
90 | 3450 | 1780 |
Total | Australia: 1 Brazil: 3 Canada: 2 Chile: 1 China: 1 Colombia: 1 Cuba: 1 Ecuador: 1 Germany: 1 Iran: 1 Ireland: 1 Italy: 2 Mexico: 1 Nepal: 1 Netherlands: 1 Saudi Arabia: 1 Serbia:1 Spain: 1 UK: 1 USA: 3 | 55 to 68.66 (mean, 7 studies) | ‐ | ‐ | ‐ | 7 studies considered mortality | 4 studies considered additional respiratory support | 15 to 90 (7 studies) | 16,185 | 9403 |
aHR: adjusted hazard ratio; aOR: adjusted odds ratio; twice daily: twice a day; CI: confidence interval; CrCl: creatinine clearance; DOACs: direct oral anticoagulants; GFR: glomerular filtration rate;HR: hazard ratio; ICU: intensive care units; IU: international unit;LMWH: low‐molecular‐weight heparin; NA: no anticoagulation; NR: not reported; NRS: non‐randomised study;OR: odds ratio; RCT: randomised controlled trial; RR: risk ratio; SC: subcutaneous; SD: standard deviation; SIC: sepsis‐induced coagulopathy; TID: three times a day; UFH: unfractionated heparin; VKA: vitamin K antagonist |
aHospital: includes intensive care unit, hospital wards or emergency department. bAnticoagulation used twice daily if glomerular filtration rate (GFR) was > 30 mL/min, or once daily if GFR was 30 mL/min or less.