PDF(Pubmed)
Abstract：
Background: Hypercoagulability and thromboembolic events are associated with poor prognosis in coronavirus disease 2019 (COVID-19) patients. Whether chronic oral anticoagulation (OAC) improve the prognosis is yet controversial. The present study aimed to investigate the association between the chronic OAC and clinical outcomes in COVID-19 patients. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were comprehensively searched to identify studies that evaluated OAC for COVID-19 until 24 July 2021. Random-effects model meta-analyses were performed to pool the relative risk (RR) and 95% confidence interval (CI) of all-cause mortality and intensive care unit (ICU) admission as primary and secondary outcomes, respectively. According to the type of oral anticoagulants [direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs)], subgroup and interaction analyses were performed to compare DOACs and VKAs. Meta-regression was performed to explore the potential confounders on all-cause mortality. Results: A total of 12 studies involving 30,646 patients met the inclusion criteria. The results confirmed that chronic OAC did not reduce the risk of all-cause mortality (RR: 0.92; 95% CI 0.82-1.03; p = 0.165) or ICU admission (RR: 0.65; 95% CI 0.40-1.04; p = 0.073) in patients with COVID-19 compared to those without OAC. The chronic use of DOACs did not reduce the risk of all-cause mortality compared to VKAs (P interaction = 0.497) in subgroup and interaction analyses. The meta-regression failed to detect any potential confounding on all-cause mortality. Conclusion: COVID-19 patients with chronic OAC were not associated with a lower risk of all-cause mortality and ICU admission compared to those without OAC, and the results were consistent across DOACs and VKA subgroups. Systematic Review Registration: clinicaltrials.gov, identifier CRD42021269764.
摘要：
背景：高凝状态和血栓栓塞事件与2019年冠状病毒病（COVID-19）患者的不良预后相关。慢性口服抗凝（OAC）是否改善预后尚存争议。本研究旨在探讨COVID-19患者的慢性OAC与临床结局之间的关系。方法:PubMed,Embase,WebofScience,和Cochrane图书馆进行了全面搜索，以确定在2021年7月24日之前评估OAC对COVID-19的研究。进行随机效应模型荟萃分析，将全因死亡率和重症监护病房（ICU）入院的相对风险（RR）和95％置信区间（CI）作为主要和次要结局。分别。根据口服抗凝剂的类型[直接口服抗凝剂（DOAC）或维生素K拮抗剂（VKAs）]，进行亚组和相互作用分析以比较DOAC和VKAs.进行元回归以探讨全因死亡率的潜在混杂因素。结果：共有12项研究，涉及30,646例患者符合纳入标准。结果证实，与没有OAC的患者相比，慢性OAC并未降低COVID-19患者的全因死亡风险（RR：0.92；95%CI0.82-1.03；p=0.165）或ICU入院风险（RR：0.65；95%CI0.40-1.04；p=0.073）。在亚组和交互作用分析中，与VKAs（P交互作用=0.497）相比，长期使用DOAC并未降低全因死亡率的风险。荟萃回归未能检测到全因死亡率的任何潜在混杂因素。结论：与没有OAC的患者相比，患有慢性OAC的COVID-19患者的全因死亡率和ICU入住风险较低，DOAC和VKA亚组的结果一致。系统审查注册：clinicaltrials.gov，标识符CRD42021269764。
