Optimal Dosing of Heparin for Prophylactic Anticoagulation in Critically Ill COVID-19 Patients a Systematic Review and Meta-Analysis of Randomized Controlled Trials

Authors

Luana CMG Bonfim, Department of Medicine, University of South Santa Catarina, Florianópolis, SC, Brazil.Follow
Isadora S. Guerini, Department of Medicine, State University of Western Paraná, Francisco Beltrão, PR, Brazil.
Marjorie G. Zambon, Department of Medicine, Mackenzie Evangelical University Hospital, Curitiba, PR, Brazil.
Gabriela B. Pires, Department of Medicine, School of Medicine Souza Marques, Rio de Janeiro, RJ, Brazil.
Amanda CF Silva, Department of Medicine, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
André LN Gobatto, Department of Critical Care, São Rafael Hospital, Salvador, Bahia, Brazil; Department of Critical Care, Hospital da Cidade, Salvador, Bahia, Brazil.
Marcela A. Lopes, Department of Critical Care, Hospital da Cidade, Salvador, Bahia, Brazil.
Shari B. Brosnahan, Department of Pulmonary and Critical Care, New York University School of Medicine, New York, NY, USA.

Document Type

Article

Publication Date

10-1-2023

Abstract

PURPOSE: The optimal amount of anticoagulation for critically ill COVID-19 patients is controversial. Therefore, we aimed to evaluate the efficacy and safety of escalated doses of anticoagulation in critically ill patients with severe COVID-19.

MATERIALS AND METHODS: We conducted a systematic search of three major databases, including PubMed, Cochrane Library, and Embase, from inception to May 2022. Randomized controlled trials (RCTs) were included comparing therapeutic or intermediate doses to standard prophylactic doses of anticoagulants in critically ill COVID-19 patients, with heparins as the only anticoagulation therapy considered.

RESULTS: Out of the six RCTs, 2130 patients were administered escalated dose anticoagulation (50.2%) and standard thromboprophylaxis therapy (49.8%). The escalated dose showed no significant impact on mortality (RR, 1.01; 95% CI, 0.90-1.13). Although there was no significant difference in DVT (RR, 0.81; 95% CI, 0.61-1.08), the risk of PE was significantly reduced in patients receiving escalated dose anticoagulation (RR, 0.35; 95% CI, 0.21-0.60), with an increased risk of bleeding events (RR, 1.65; 95% CI, 1.08-2.53).

CONCLUSION: This systematic review and meta-analysis fail to support escalated anticoagulation doses to reduce mortality in critically ill COVID-19 patients. However, higher doses of anticoagulants appear to reduce thrombotic events while increasing the risk of bleeding effectively.

Recommended Citation

Bonfim LCMG, Guerini IS, Zambon MG, Pires GB, Silva ACF, Gobatto ALN, Lopes MA, Brosnahan SB. Optimal dosing of heparin for prophylactic anticoagulation in critically ill COVID-19 patients a systematic review and meta-analysis of randomized controlled trials. J Crit Care. 2023 Oct;77:154344. doi: 10.1016/j.jcrc.2023.154344. Epub 2023 May 25. PMID: 37244209; PMCID: PMC10211463.