Effect of therapeutic dose anticoagulation vs prophylactic dose anticoagulation in reducing venous thromboembolism, arterial thrombosis or death events among hospitalized non-critically ill COVID19 pt

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Title The Effect of Therapeutic Dose Anticoagulation Versus Prophylactic Dose Anticoagulation in Reducing Venous Thromboembolism (VTE), Arterial Thrombosis (ATE) or Death Events Among Hospitalized Non-critically Ill COVID-19 Patients: A Meta-analysis. Background Coagulopathy-associated thrombotic events, leading to venous and arterial thromboembolism are highly prevalent among COVID-19 patients. While pharmacologic thromboprophylaxis are the mainstays of treatment, the consideration for an escalated therapeutic dose anticoagulation in the non-critically ill remained a highly debated issue. Objectives This meta-analysis sought to evaluate whether therapeutic dose anticoagulation among hospitalized non-critically ill COVID-19 patients reduce the composite primary efficacy outcome (VTE, ATE or death), and the secondary outcomes of major bleeding risk and progression to intubation and mechanical ventilation compared to prophylactic dose anticoagulation. Methodology After extensive search, screening based on predefined inclusion and exclusion criteria and critical appraisal by 3 independent reviewers 3 eligible open label RTCs with a total of 1492 patients were included in the study. The event rates of the primary and secondary outcomes were assessed after 21-30 days of hospitalization. Results The Risk Ratio for VTE, ATE and death is higher in the prophylactic dose anticoagulation (RR 1.42; 95% CI 1.08-1.86), p-value <0.05) compared to therapeutic dose anticoagulation. The risk for major bleeding (RR 0.70; 95% CI 0.30-1.62, p-value >0.05) and progression to intubation and mechanical ventilation (RR of 1.13; 95% CI 0.93-1.38, p-value >0.05) were not significantly different between the dosing regimens. Conclusion Therapeutic-dose regimen among non-critically ill admitted COVID-19 patients conferred lower risk for the composite primary outcome of VTE, ATE and death with similar risk for bleeding compared to prophylactic dose regimen. Due to this outcome advantage, therapeutic-dose anticoagulation can be considered as initial regimen in the non-critically ill COVID-19 patients in the absence of contraindications.