■由于静脉血栓栓塞(VTE)的高风险,抗凝对于2019年冠状病毒病(COVID-19)住院的患者至关重要。然而,最佳抗凝方案有待进一步探索。因此,我们评估了不同抗凝剂量对COVID-19的疗效和安全性.
■进行了更新的荟萃分析以评估血栓预防的效果(标准,中间,和治疗剂量)对VTE的发生率,COVID-19患者的死亡率和大出血。文献是通过PubMed搜索的,EMBASE,WebofScience,和中国国家知识基础设施(CNKI)数据库。计算比值比(OR)和95%置信区间(CI)用于效果估计。
■纳入了19项研究,涉及25,289名无VTE病史的参与者。患者平均年龄为59.3岁。约有50.96%被送往重症监护病房。在汇总分析中,与标准剂量相比,治疗剂量和中剂量抗凝在降低VTE风险方面均无显著优势(分别为OR=1.09,95%CI:0.58~2.02和OR=0.89,95%CI:0.70~1.12).同样,治疗剂量组(OR=1.12,95%CI:0.75~1.67)或中剂量组(OR=1.34,95%CI:0.83~2.17)的全因死亡率均未进一步降低.与标准剂量方案相比,治疗剂量组的大出血风险显着升高(OR=2.59,95CI:1.87-3.57)。与中间剂量相比,治疗性抗凝并没有降低随后的VTE风险(OR=0.85,95%CI:0.52-1.38)和全因死亡率(OR=0.84,95%CI:0.60-1.17),但显著增加大出血率(OR=2.42,95%CI:1.58-3.70)。在65岁以上患者的亚组分析中,与标准的血栓预防相比,治疗性抗凝能显著降低VTE的发生率,然而,以大出血风险升高为代价。
■我们的结果表明,对于大多数COVID-19住院患者,标准剂量预防性抗凝可能是最佳选择。对于出血风险低的老年患者,治疗剂量抗凝能进一步降低VTE风险,尤其是在住院期间有其他强VTE危险因素时,应加以考虑.
■https://www.crd.约克。AC.英国/PROSPERO,标识符,CRD42023388429。
UNASSIGNED: Anticoagulation is crucial for patients hospitalized with coronavirus disease 2019 (COVID-19) due to the high risk of venous thromboembolism (VTE). However, the optimal anticoagulation regimen needs further exploration. Therefore, we evaluated the efficacy and safety of diverse anticoagulation dosage dosages for COVID-19.
UNASSIGNED: An updated meta-analysis was performed to assess the effect of
thromboprophylaxis (standard, intermediate, and therapeutic dose) on the incidence of VTE, mortality and major bleeding among COVID-19 patients. Literature was searched via PubMed, EMBASE, Web of Science, and
China National Knowledge Infrastructure (CNKI) database. The odds ratio (OR) and 95% confidence interval (CI) were calculated for effect estimates.
UNASSIGNED: Nineteen studies involving 25,289 participants without VTE history were included. The mean age of patients was 59.3 years old. About 50.96% were admitted to the intensive care unit. In the pooled analysis, both therapeutic-dose and intermediate-dose anticoagulation did not have a significant advantage in reducing VTE risk over standard dosage (OR = 1.09, 95% CI: 0.58-2.02, and OR = 0.89, 95% CI: 0.70-1.12, respectively). Similarly, all-cause mortality was not further decreased in either therapeutic-dose group (OR = 1.12, 95% CI: 0.75-1.67) or intermediate-dose group (OR = 1.34, 95% CI: 0.83-2.17). While the major bleeding risk was significantly elevated in the therapeutic-dose group (OR = 2.59, 95%CI: 1.87-3.57) as compared with the standard-dose regimen. Compared with intermediate dosage, therapeutic anticoagulation did not reduce consequent VTE risk (OR = 0.85, 95% CI: 0.52-1.38) and all-cause mortality (OR = 0.84, 95% CI: 0.60-1.17), but significantly increased major bleeding rate (OR = 2.42, 95% CI: 1.58-3.70). In subgroup analysis of patients older than 65 years, therapeutic anticoagulation significantly lowered the incidence of VTE in comparation comparison with standard
thromboprophylaxis, however, at the cost of elevated risk of major bleeding.
UNASSIGNED: Our results indicated that for most hospitalized patients with COVID-19, standard-dose prophylactic anticoagulation might be the optimal choice. For elderly patients at low risk of bleeding, therapeutic-dose anticoagulation could further reduce VTE risk and should be considered especially when there were other strong risk factors of VTE during hospital stay.
UNASSIGNED: https://www.crd.york.ac.uk/PROSPERO, identifier, CRD42023388429.