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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Anticoagulant use before COVID-19 diagnosis prevent COVID-19 associated acute venous thromboembolism or not: A systematic review and meta-analysis
Kinza Iqbal, Akshat Banga, Taha Bin Arif, Sawai Singh Rathore, Abhishek Bhurwal, Syeda Kisa Batool Naqvi, Muhammad Mehdi, Pankaj Kumar, Mitali Madhu Salklan, Ayman Iqbal, Jawad Ahmed, Nikhil Sharma, Amos Lal, Rahul Kashyap, Vikas Bansal, Juan Pablo Domecq
Kinza Iqbal, Taha Bin Arif, Syeda Kisa Batool Naqvi, Muhammad Mehdi, Pankaj Kumar, Ayman Iqbal, Jawad Ahmed, Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
Akshat Banga, Department of Internal Medicine, Sawai Man Singh Medical College, Jaipur 302004, India
Sawai Singh Rathore, Department of Internal Medicine, Dr. Sampurnanand Medical College, Jodhpur 342003, Rajasthan, India
Abhishek Bhurwal, Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ 08901, United States
Mitali Madhu Salklan, Department of Internal Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak 124001, Haryana, India
Nikhil Sharma, Vikas Bansal, Juan Pablo Domecq, Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States
Amos Lal, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
Rahul Kashyap, Department of Research, Wellspan Health, York, PA 17403, United States
Co-first authors: Kinza Iqbal and Akshat Banga.
Co-corresponding authors: Vikas Bansal and Juan Pablo Domecq.
Author contributions: Iqbal K and Bansal V contributed equally to defining the study outline and manuscript writing; Data review and collection were done by Banga A, Iqbal A, Ahmed J, Iqbal K, Sharma N, Mehdi M, Kumar P, and Rathore SS; Statistical analysis was done by Banga A, Iqbal K, and Bansal V; Study design and critical review are done by Banga A, Lal A, Domecq JP, Kashyap R, and Bansal V; Iqbal K and Bansal V are the co-corresponding authors of the paper, taking responsibility for the integrity of the work from inception to the published article; all authors contributed to the article and approved the submitted version. Bansal V and Domecq JP contributed equally to this work and are considered co- corresponding authors.
Conflict-of-interest statement: Dr. Bansal has nothing to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Vikas Bansal, MBBS, Associate Research Scientist, Department of Nephrology and Hypertension, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, Rochester, MN 55905, United States. bansal.vikas@mayo.edu
Received: February 15, 2024
Revised: April 24, 2024
Accepted: May 11, 2024
Published online: September 20, 2024
Processing time: 131 Days and 10.3 Hours
BACKGROUND
Coagulopathy and thromboembolic events are associated with poor outcomes in coronavirus disease 2019 (COVID-19) patients. There is conflicting evidence on the effects of chronic anticoagulation on mortality and severity of COVID-19 disease.
AIM
To summarize the body of evidence on the effects of pre-hospital anticoagulation on outcomes in COVID-19 patients.
METHODS
A Literature search was performed on LitCovid PubMed, WHO, and Scopus databases from inception (December 2019) till June 2023 for original studies reporting an association between prior use of anticoagulants and patient outcomes in adults with COVID-19. The primary outcome was the risk of thromboembolic events in COVID-19 patients taking anticoagulants. Secondary outcomes included COVID-19 disease severity, in terms of intensive care unit admission or invasive mechanical ventilation/intubation requirement in patients hospitalized with COVID-19 infection, and mortality. The random effects models were used to calculate crude and adjusted odds ratios (aORs) with 95% confidence intervals (95%CIs).
RESULTS
Forty-six observational studies met our inclusion criteria. The unadjusted analysis found no association between prior anticoagulation and thromboembolic event risk [n = 43851, 9 studies, odds ratio (OR)= 0.67 (0.22, 2.07); P = 0.49; I2 = 95%]. The association between prior anticoagulation and disease severity was non-significant [n = 186782; 22 studies, OR = 1.08 (0.78, 1.49); P = 0.64; I2 = 89%]. However, pre-hospital anticoagulation significantly increased all-cause mortality risk [n = 207292; 35 studies, OR = 1.72 (1.37, 2.17); P < 0.00001; I2 = 93%]. Pooling adjusted estimates revealed a statistically non-significant association between pre-hospital anticoagulation and thromboembolic event risk [aOR = 0.87 (0.42, 1.80); P = 0.71], mortality [aOR = 0.94 (0.84, 1.05); P = 0.31], and disease severity [aOR = 0.96 (0.72, 1.26); P = 0.76].
CONCLUSION
Prehospital anticoagulation was not significantly associated with reduced risk of thromboembolic events, improved survival, and lower disease severity in COVID-19 patients.
Core Tip: Coronavirus disease 2019 (COVID-19) patients are at an increased risk of developing thromboembolic events and hypercoagulable disorders, which are poor prognostic indicators of COVID-19 disease. The results of different observational studies on the effects of chronic anticoagulation on the mortality and severity of COVID-19 disease in infected patients are inconsistent. This systematic review and meta-analysis provide a comprehensive assessment of the risk of thromboembolic events, mortality, and severity of COVID-19 disease in patients on prehospital anticoagulation treatment.
