Matches in SemOpenAlex for { <https://semopenalex.org/work/W4226407007> ?p ?o ?g. }
- W4226407007 abstract "Background The primary manifestation of coronavirus disease 2019 (COVID‐19) is respiratory insufficiency that can also be related to diffuse pulmonary microthrombosis and thromboembolic events, such as pulmonary embolism, deep vein thrombosis, or arterial thrombosis. People with COVID‐19 who develop thromboembolism have a worse prognosis. Anticoagulants such as heparinoids (heparins or pentasaccharides), vitamin K antagonists and direct anticoagulants are used for the prevention and treatment of venous or arterial thromboembolism. Besides their anticoagulant properties, heparinoids have an additional anti‐inflammatory potential. However, the benefit of anticoagulants for people with COVID‐19 is still under debate. Objectives To assess the benefits and harms of anticoagulants versus active comparator, placebo or no intervention in people hospitalised with COVID‐19. Search methods We searched the CENTRAL, MEDLINE, Embase, LILACS and IBECS databases, the Cochrane COVID‐19 Study Register and medRxiv preprint database from their inception to 14 April 2021. We also checked the reference lists of any relevant systematic reviews identified, and contacted specialists in the field for additional references to trials. Selection criteria Eligible studies were randomised controlled trials (RCTs), quasi‐RCTs, cluster‐RCTs and cohort studies that compared prophylactic anticoagulants versus active comparator, placebo or no intervention for the management of people hospitalised with COVID‐19. We excluded studies without a comparator group and with a retrospective design (all previously included studies) as we were able to include better study designs. Primary outcomes were all‐cause mortality and necessity for additional respiratory support. Secondary outcomes were mortality related to COVID‐19, deep vein thrombosis, pulmonary embolism, major bleeding, adverse events, length of hospital stay and quality of life. Data collection and analysis We used standard Cochrane methodological procedures. We used Cochrane RoB 1 to assess the risk of bias for RCTs, ROBINS‐I to assess risk of bias for non‐randomised studies (NRS) and GRADE to assess the certainty of evidence. We meta‐analysed data when appropriate. Main results We included seven studies (16,185 participants) with participants hospitalised with COVID‐19, in either intensive care units, hospital wards or emergency departments. Studies were from Brazil (2), Iran (1), Italy (1), and the USA (1), and two involved more than country. The mean age of participants was 55 to 68 years and the follow‐up period ranged from 15 to 90 days. The studies assessed the effects of heparinoids, direct anticoagulants or vitamin K antagonists, and reported sparse data or did not report some of our outcomes of interest: necessity for additional respiratory support, mortality related to COVID‐19, and quality of life. Higher‐dose versus lower‐dose anticoagulants (4 RCTs, 4647 participants) Higher‐dose anticoagulants result in little or no difference in all‐cause mortality (risk ratio (RR) 1.03, 95% CI 0.92 to 1.16, 4489 participants; 4 RCTs) and increase minor bleeding (RR 3.28, 95% CI 1.75 to 6.14, 1196 participants; 3 RCTs) compared to lower‐dose anticoagulants up to 30 days (high‐certainty evidence). Higher‐dose anticoagulants probably reduce pulmonary embolism (RR 0.46, 95% CI 0.31 to 0.70, 4360 participants; 4 RCTs), and slightly increase major bleeding (RR 1.78, 95% CI 1.13 to 2.80, 4400 participants; 4 RCTs) compared to lower‐dose anticoagulants up to 30 days (moderate‐certainty evidence). Higher‐dose anticoagulants may result in little or no difference in deep vein thrombosis (RR 1.08, 95% CI 0.57 to 2.03, 3422 participants; 4 RCTs), stroke (RR 0.91, 95% CI 0.40 to 2.03, 4349 participants; 3 RCTs), major adverse limb events (RR 0.33, 95% CI 0.01 to 7.99, 1176 participants; 2 RCTs), myocardial infarction (RR 0.86, 95% CI 0.48 to 1.55, 4349 participants; 3 RCTs), atrial fibrillation (RR 0.35, 95% CI 0.07 to 1.70, 562 participants; 1 study), or thrombocytopenia (RR 0.94, 95% CI 0.71 to 1.24, 2789 participants; 2 RCTs) compared to lower‐dose anticoagulants up to 30 days (low‐certainty evidence). It is unclear whether higher‐dose anticoagulants have any effect on necessity for additional respiratory support, mortality related to COVID‐19, and quality of life (very low‐certainty evidence or no data). Anticoagulants versus no treatment (3 prospective NRS, 11,538 participants) Anticoagulants may reduce all‐cause mortality but the evidence is very uncertain due to two study results being at critical and serious risk of bias (RR 0.64, 95% CI 0.55 to 0.74, 8395 participants; 3 NRS; very low‐certainty evidence). It is uncertain if anticoagulants have any effect on necessity for additional respiratory support, mortality related to COVID‐19, deep vein thrombosis, pulmonary embolism, major bleeding, stroke, myocardial infarction and quality of life (very low‐certainty evidence or no data). Ongoing studies We found 62 ongoing studies in hospital settings (60 RCTs, 35,470 participants; 2 prospective NRS, 120 participants) in 20 different countries. Thirty‐five ongoing studies plan to report mortality and 26 plan to report necessity for additional respiratory support. We expect 58 studies to be completed in December 2021, and four in July 2022. From 60 RCTs, 28 are comparing different doses of anticoagulants, 24 are comparing anticoagulants versus no anticoagulants, seven are comparing different types of anticoagulants, and one did not report detail of the comparator group. Authors' conclusions When compared to a lower‐dose regimen, higher‐dose anticoagulants result in little to no difference in all‐cause mortality and increase minor bleeding in people hospitalised with COVID‐19 up to 30 days. Higher‐dose anticoagulants possibly reduce pulmonary embolism, slightly increase major bleeding, may result in little to no difference in hospitalisation time, and may result in little to no difference in deep vein thrombosis, stroke, major adverse limb events, myocardial infarction, atrial fibrillation, or thrombocytopenia. Compared with no treatment, anticoagulants may reduce all‐cause mortality but the evidence comes from non‐randomised studies and is very uncertain. It is unclear whether anticoagulants have any effect on the remaining outcomes compared to no anticoagulants (very low‐certainty evidence or no data). Although we are very confident that new RCTs will not change the effects of different doses of anticoagulants on mortality and minor bleeding, high‐quality RCTs are still needed, mainly for the other primary outcome (necessity for additional respiratory support), the comparison with no anticoagulation, when comparing the types of anticoagulants and giving anticoagulants for a prolonged period of time." @default.
- W4226407007 created "2022-05-05" @default.
- W4226407007 creator A5000264599 @default.
- W4226407007 creator A5011139272 @default.
- W4226407007 creator A5023830488 @default.
- W4226407007 creator A5024459640 @default.
- W4226407007 creator A5033291939 @default.
- W4226407007 creator A5043924180 @default.
- W4226407007 creator A5044388085 @default.
- W4226407007 creator A5053730361 @default.
- W4226407007 creator A5066236556 @default.
- W4226407007 creator A5076228132 @default.
- W4226407007 date "2022-03-04" @default.
- W4226407007 modified "2023-10-06" @default.
- W4226407007 title "Anticoagulants for people hospitalised with COVID-19" @default.
- W4226407007 cites W2018856451 @default.
- W4226407007 cites W2020613436 @default.
- W4226407007 cites W2036385193 @default.
- W4226407007 cites W2037377025 @default.
- W4226407007 cites W2125435699 @default.
- W4226407007 cites W2170892587 @default.
- W4226407007 cites W2531269403 @default.
- W4226407007 cites W2567362164 @default.
- W4226407007 cites W2911305289 @default.
- W4226407007 cites W3011926357 @default.
- W4226407007 cites W3013486442 @default.
- W4226407007 cites W3013556081 @default.
- W4226407007 cites W3013710636 @default.
- W4226407007 cites W3014329201 @default.
- W4226407007 cites W3015631662 @default.
- W4226407007 cites W3015863623 @default.
- W4226407007 cites W3015886046 @default.
- W4226407007 cites W3016186932 @default.
- W4226407007 cites W3016808868 @default.
- W4226407007 cites W3016965546 @default.
- W4226407007 cites W3017326650 @default.
- W4226407007 cites W3017743621 @default.
- W4226407007 cites W3019029446 @default.
- W4226407007 cites W3019350884 @default.
- W4226407007 cites W3020735691 @default.
- W4226407007 cites W3021591080 @default.
- W4226407007 cites W3021954309 @default.
- W4226407007 cites W3022226924 @default.
- W4226407007 cites W3022564719 @default.
- W4226407007 cites W3024018593 @default.
- W4226407007 cites W3027918021 @default.
- W4226407007 cites W3028776453 @default.
- W4226407007 cites W3028989873 @default.
- W4226407007 cites W3029192481 @default.
- W4226407007 cites W3029761916 @default.
- W4226407007 cites W3031456278 @default.
- W4226407007 cites W3033337964 @default.
- W4226407007 cites W3034615397 @default.
- W4226407007 cites W3035959133 @default.
- W4226407007 cites W3036203801 @default.
- W4226407007 cites W3037121760 @default.
- W4226407007 cites W3037344916 @default.
- W4226407007 cites W3037887855 @default.
- W4226407007 cites W3038144303 @default.
- W4226407007 cites W3041023147 @default.
- W4226407007 cites W3041992145 @default.
- W4226407007 cites W3042554361 @default.
- W4226407007 cites W3043015313 @default.
- W4226407007 cites W3044050205 @default.
- W4226407007 cites W3044820935 @default.
- W4226407007 cites W3046375596 @default.
- W4226407007 cites W3046643516 @default.
- W4226407007 cites W3046831909 @default.
- W4226407007 cites W3049429955 @default.
- W4226407007 cites W3076472136 @default.
- W4226407007 cites W3081702754 @default.
- W4226407007 cites W3082394522 @default.
- W4226407007 cites W3082558676 @default.
- W4226407007 cites W3083721556 @default.
- W4226407007 cites W3087287769 @default.
- W4226407007 cites W3087656790 @default.
- W4226407007 cites W3088000334 @default.
- W4226407007 cites W3088228669 @default.
- W4226407007 cites W3089370525 @default.
- W4226407007 cites W3090495367 @default.
- W4226407007 cites W3090555129 @default.
- W4226407007 cites W3090593221 @default.
- W4226407007 cites W3092513774 @default.
- W4226407007 cites W3093269129 @default.
- W4226407007 cites W3094039314 @default.
- W4226407007 cites W3096248644 @default.
- W4226407007 cites W3096815097 @default.
- W4226407007 cites W3096942772 @default.
- W4226407007 cites W3097031935 @default.
- W4226407007 cites W3097177168 @default.
- W4226407007 cites W3099370730 @default.
- W4226407007 cites W3101000693 @default.
- W4226407007 cites W3107421748 @default.
- W4226407007 cites W3108305841 @default.
- W4226407007 cites W3110213126 @default.
- W4226407007 cites W3110333120 @default.
- W4226407007 cites W3111783340 @default.
- W4226407007 cites W3113607491 @default.
- W4226407007 cites W3117685539 @default.
- W4226407007 cites W3118615836 @default.