SESSION TITLE: Treatment Debates in Critical Care
SESSION TYPE: Rapid Fire Original Inv
PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm
PURPOSE: Studies have reported various estimates of the incidence of venous thromboembolism (VTE) and major bleeding among hospitalized patients with COVID-19, with varying doses and types of anticoagulation used in each study. While patients hospitalized with COVID-19 may have a higher incidence of VTE, there may also be an increased incidence of bleeding. The risk of VTE needs to be weighed against the increased risk of bleeding when considering higher than standard dose prophylactic anticoagulation. This review examines the incidence and risk of thromboembolism and major bleeding in hospitalized patients with COVID-19 pneumonia across randomized controlled trials.
METHODS: Online databases including PubMed, CINAHL, Ovid, and Cochrane were searched from the inception of literature through January 11th, 2022, following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Only articles published in the English language were included. Abstracts, case reports, and case series were excluded from this systematic analysis. Out of 168 studies, 8 randomized controlled trials were selected for a systematic review.
RESULTS: In the 8 studies considered for this review, a total of 4,913 COVID patients were randomized to either prophylactic or therapeutic dose anticoagulation. Thrombotic events, major bleeding, and overall mortality were set as endpoints. Seven out of eight studies used heparin/low molecular weight heparin and only one used rivaroxaban. All except one study (Perepu et. al) reported a lower percentage of thrombotic events in the therapeutic group. Similarly, all except one study (Sholzberg et. al) reported a higher percentage of major bleed in the therapeutic group. In 4 out of 8 studies higher overall mortality was reported in the therapeutic group. However, only two values reported were statistically significant. Syropoulos et al reported a lower thrombotic event percentage in the therapeutic group with a p-value of <0.001% and Sholzberg et al reported a lower mortality percentage in the therapeutic group with the p-value of 0.006%.
CONCLUSIONS: Therapeutic anticoagulation in COVID is a double-edged sword, decreased incidence of thrombotic events and an increased incidence of major bleeding was seen in the patients on therapeutic dose anticoagulation. Only one study reported a statistically significant decreased mortality in the therapeutic group and none of the studies reported a statistically significant major bleeding in the therapeutic group.
CLINICAL IMPLICATIONS: Based on the finding of this study we would recommend against the use of therapeutic anticoaguation in hospitalized patients with COVID-19.
DISCLOSURES: No relevant relationships by Faiz Anwer
No relevant relationships by Ahmed Elkhapery
No relevant relationships by Unaiza Faizan
No relevant relationships by Deeptanshu Jain