tetano
Editor, Senior Moderator
Ther Adv Neurol Disord
. 2022 May 24;15:17562864221099472.
doi: 10.1177/17562864221099472. eCollection 2022.
Effects of low molecular weight heparin and fondaparinux on mortality, hemorrhagic and thrombotic complications in COVID-19 patients
Paraskevi C Fragkou[SUP] 1 [/SUP], Lina Palaiodimou[SUP] 2 [/SUP], Maria Ioanna Stefanou[SUP] 2 [/SUP], Aristeidis H Katsanos[SUP] 3 [/SUP], Vaia Lambadiari[SUP] 4 [/SUP], Dimitrios Paraskevis[SUP] 5 [/SUP], Elisabeth Andreadou[SUP] 6 [/SUP], Dimitra Dimopoulou[SUP] 7 [/SUP], Christina Zompola[SUP] 2 [/SUP], Panagiotis Ferentinos[SUP] 8 [/SUP], Theodoros I Vassilakopoulos[SUP] 9 [/SUP], Anastasia Kotanidou[SUP] 1 [/SUP], Petros P Sfikakis[SUP] 10 [/SUP], Sotirios Tsiodras[SUP] 11 [/SUP], Georgios Tsivgoulis[SUP] 12 [/SUP]
Affiliations
Abstract
Background: Coronavirus disease 2019 (COVID-19) is associated with increased thrombosis prevalence. However, there are insufficient data supporting the appropriate anticoagulation dose in COVID-19.
Objective: We aim to systematically assess the currently available data regarding the effects of different dosing regimens of low molecular weight heparin and/or fondaparinux (LMWH/F) on mortality risk as well as the risk of arterial/venous thrombotic events and hemorrhagic complications in confirmed COVID-19 cases.
Design: We conducted a living systematic review and meta-analysis on the effects of different LMWH/F doses on mortality, thrombotic and hemorrhagic events in COVID-19 patients.
Data sources and methods: MEDLINE, Scopus, Embase, Cochrane Library, Cochrane COVID-19 study register, European Union Drug Regulating Authorities Clinical Trials Database, and ClinicalTrials.gov were searched to detect observational cohort studies and randomized-controlled clinical trials (RCTs) comparing difference doses of LMWH/F among confirmed COVID-19 cases.
Results: Thirty-one eligible studies (6 RCTs and 25 cohort studies) with 11,430 hospitalized patients were included. No association was found between LMWH/F and mortality during the following comparisons: (1) no LMWH/F versus any LMWH/F; (2) prophylactic versus higher than prophylactic LMWH/F; (3) prophylactic versus therapeutic LMWH/F; (4) intermediate versus therapeutic LMWH/F; and (5) lower than therapeutic versus therapeutic LMWH/F. Mortality was higher in patients receiving prophylactic versus intermediate LMWH/F (OR = 2.01; 95% CI: 1.19-3.39). However, this effect was mostly driven by observational data. No associations were detected between the intensity of LMWH/F and the risk of thrombotic and hemorrhagic events, except the lower risk for hemorrhage in patients on prophylactic compared to higher LMWH/F doses.
Conclusion: The risk for all-cause mortality was higher in patients receiving prophylactic LMWH/F compared to those on an intermediate dose of LMWH/F, based on observational data. These results should be interpreted in light of the moderate quality and heterogeneity of the included studies.
Registration: The study protocol has been registered in the International Prospective Register of Ongoing Systematic Reviews PROSPERO (Registration number: CRD42021229771).
Keywords: COVID-19; SARS-CoV-2; fondaparinux; low molecular weight heparin; mortality.
. 2022 May 24;15:17562864221099472.
doi: 10.1177/17562864221099472. eCollection 2022.
Effects of low molecular weight heparin and fondaparinux on mortality, hemorrhagic and thrombotic complications in COVID-19 patients
Paraskevi C Fragkou[SUP] 1 [/SUP], Lina Palaiodimou[SUP] 2 [/SUP], Maria Ioanna Stefanou[SUP] 2 [/SUP], Aristeidis H Katsanos[SUP] 3 [/SUP], Vaia Lambadiari[SUP] 4 [/SUP], Dimitrios Paraskevis[SUP] 5 [/SUP], Elisabeth Andreadou[SUP] 6 [/SUP], Dimitra Dimopoulou[SUP] 7 [/SUP], Christina Zompola[SUP] 2 [/SUP], Panagiotis Ferentinos[SUP] 8 [/SUP], Theodoros I Vassilakopoulos[SUP] 9 [/SUP], Anastasia Kotanidou[SUP] 1 [/SUP], Petros P Sfikakis[SUP] 10 [/SUP], Sotirios Tsiodras[SUP] 11 [/SUP], Georgios Tsivgoulis[SUP] 12 [/SUP]
Affiliations
- PMID: 35646159
- PMCID: PMC9136435
- DOI: 10.1177/17562864221099472
Abstract
Background: Coronavirus disease 2019 (COVID-19) is associated with increased thrombosis prevalence. However, there are insufficient data supporting the appropriate anticoagulation dose in COVID-19.
Objective: We aim to systematically assess the currently available data regarding the effects of different dosing regimens of low molecular weight heparin and/or fondaparinux (LMWH/F) on mortality risk as well as the risk of arterial/venous thrombotic events and hemorrhagic complications in confirmed COVID-19 cases.
Design: We conducted a living systematic review and meta-analysis on the effects of different LMWH/F doses on mortality, thrombotic and hemorrhagic events in COVID-19 patients.
Data sources and methods: MEDLINE, Scopus, Embase, Cochrane Library, Cochrane COVID-19 study register, European Union Drug Regulating Authorities Clinical Trials Database, and ClinicalTrials.gov were searched to detect observational cohort studies and randomized-controlled clinical trials (RCTs) comparing difference doses of LMWH/F among confirmed COVID-19 cases.
Results: Thirty-one eligible studies (6 RCTs and 25 cohort studies) with 11,430 hospitalized patients were included. No association was found between LMWH/F and mortality during the following comparisons: (1) no LMWH/F versus any LMWH/F; (2) prophylactic versus higher than prophylactic LMWH/F; (3) prophylactic versus therapeutic LMWH/F; (4) intermediate versus therapeutic LMWH/F; and (5) lower than therapeutic versus therapeutic LMWH/F. Mortality was higher in patients receiving prophylactic versus intermediate LMWH/F (OR = 2.01; 95% CI: 1.19-3.39). However, this effect was mostly driven by observational data. No associations were detected between the intensity of LMWH/F and the risk of thrombotic and hemorrhagic events, except the lower risk for hemorrhage in patients on prophylactic compared to higher LMWH/F doses.
Conclusion: The risk for all-cause mortality was higher in patients receiving prophylactic LMWH/F compared to those on an intermediate dose of LMWH/F, based on observational data. These results should be interpreted in light of the moderate quality and heterogeneity of the included studies.
Registration: The study protocol has been registered in the International Prospective Register of Ongoing Systematic Reviews PROSPERO (Registration number: CRD42021229771).
Keywords: COVID-19; SARS-CoV-2; fondaparinux; low molecular weight heparin; mortality.