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. 2022 Mar 4;2022(3):CD013739. doi: 10.1002/14651858.CD013739.pub2

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
  • SC UFH (5000 IU twice daily or 3 times/day (1094 participants; 30.2%)

  • LMWH (enoxaparin 40 mg once or twice daily (2506 participants; 69.1%), fondaparinux 2.5 mg once daily (4 participants; 0.1%), dalteparin 2500‐5000 IU once daily, all SC)

  • DOACs (apixaban 2.5 mg twice daily (21 participants; 0.6%), rivaroxaban 10 mg once daily or 2.5 mg twice daily (2 participants; 0.1%), dabigatran 220 mg once daily, all orally)


 
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): 
  • 327 (12%) participants = previous anticoagulation treatment

  • 1888 (72%) participants = prophylactic (lower‐dose) during hospitalisation

  • 341 (13%) participants = therapeutic (higher‐dose) LMWH

  • 23 (0.75%) oral anticoagulation with VKA

  • 23 (0.75%) DOACs


 
 
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.