A therapeutic dose of anticoagulation with herapins also reduced the need for mechanical ventilation and the risk of thromboembolic events.
RT’s Three Key Takeaways:
- Reduced Mortality: Therapeutic doses of anticoagulants with heparins were associated with a 23% reduction in 28-day mortality for hospitalized COVID-19 patients compared to prophylactic doses.
- Improved Clinical Outcomes: Higher-dose anticoagulation also led to fewer cases requiring invasive mechanical ventilation and reduced thromboembolic events in hospitalized patients.
- Increased Bleeding Risk: While therapeutic anticoagulation lowered mortality and complications, it also increased the risk of major bleeding, though the benefits outweighed this risk in most cases, according to researchers.
A prospective meta-analysis of clinical trials examined the effects of high and low doses of anticoagulation for hospitalized patients with COVID-19. It found that administering therapeutic dose anticoagulation with heparins reduced mortality, the need for invasive mechanical ventilation, and thromboembolic events compared with prophylactic dose heparins.
The findings are published in Annals of Internal Medicine.
Researchers funded by the World Health Organization studied data from 18 randomized clinical trials that randomly assigned patients hospitalized for COVID-19 to higher versus lower doses of anticoagulants. The intensity of the anticoagulant used was classified as prophylactic, intermediate, or therapeutic dosing.
[RELATED: Anticoagulant Beneficial For COVID-19 Patients, Study Finds]
The objective of the study was to estimate intention-to-treat effects of therapeutic versus prophylactic; therapeutic versus intermediate; and intermediate versus prophylactic dose anticoagulation in hospitalized patients with suspected or confirmed COVID-19.
Impact of Anticoagulant Dose on Mortality and Ventilation
The primary outcome was all-cause mortality by 28 days after randomization, and secondary outcomes were progression to invasive mechanical ventilation or death, thromboembolic events, and major bleeding.
The majority of trials studied evaluated heparins, including enoxaparin, tinzaparin, or dalteparin, so the researchers focused their findings on anticoagulation using heparins. The researchers found that administering therapeutic versus prophylactic-dose anticoagulation to patients hospitalized for COVID-19 was associated with 23% lower 28-day mortality.
Mortality was higher for therapeutic versus intermediate-dose anticoagulation; however, the researchers note that this comparison was not estimated precisely. Mortality risk was similar for intermediate versus prophylactic dose anticoagulation. The risk of progression to invasive mechanical ventilation or death was similar to mortality risk.
Across all dosage comparisons, the risk for major bleeding was higher, but the risk for thromboembolic events was lower. The findings suggest a high certainty that therapeutic dose anticoagulation of heparin reduces 28-day mortality in hospitalized patients with COVID-19.
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