Эффекты эноксапарина в лечебных и терапевтических дозах при COVID-19: систематический обзор и мета-анализ

Abstract

Thrombotic complications are the most dangerous manifestations of COVID-19. This justifies the need for anticoagulant therapy in a new coronavirus infection. The effects of enoxaparin at therapeutic and prophylactic doses in COVID-19 were assessed from a meta-analysis of 5 randomized clinical trials (RCTs). Search for RCTs was performed in the MEDLINE, Cochrane, PubMed, and ClinicalTrials.gov databases. Odds ratio (OR) with 95% confidence interval and heterogeneity were calculated applying RevMan 5.4.1 software. Combined criterion for the effectiveness of anticoagulant therapy included mortality and thrombotic events (arterial and venous thrombosis). The safety of enoxaparin was assessed by the frequency of bleeding (secondary outcomes). There were no statistically significant differences in mortality in COVID-19 patients receiving enoxaparin at therapeutic doses compared with prophylactic doses [OR = 0.98; 95% CI 0.84 – 1.16; p = 0.85]. The frequency of thrombosis and thromboembolism when using enoxaparin in therapeutic doses was lower compared with prophylactic doses [OR = 0.80; 95% CI 0.66 – 0.98; p = 0.03], while the frequency of bleeding was higher [OR = 2.11; 95% CI 1.36 – 3.30; p = 0.0009]. This meta-analysis suggests a greater efficacy of enoxaparin at therapeutic doses in reducing the incidence of thrombotic complications in hospitalized COVID-19 patients, however, these data require clarification. Further multicenter randomized controlled trials are needed to determine the optimal anticoagulant regimens in COVID-19 patients.