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

doi:10.5662/wjm.v14.i3.92983

Anticoagulant use before COVID-19 diagnosis prevent COVID-19 associated acute venous thromboembolism or not: A systematic review and meta-analysis

World J Methodol. 2024 Sep 20;14(3):92983. doi: 10.5662/wjm.v14.i3.92983.

Authors

Affiliations

¹ Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan.
² Department of Internal Medicine, Sawai Man Singh Medical College, Jaipur 302004, India.
³ Department of Internal Medicine, Dr. Sampurnanand Medical College, Jodhpur 342003, Rajasthan, India.
⁴ Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ 08901, United States.
⁵ Department of Internal Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak 124001, Haryana, India.
⁶ Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States.
⁷ Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States.
⁸ Department of Research, Wellspan Health, York, PA 17403, United States.
⁹ Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States. bansal.vikas@mayo.edu.

Abstract

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; I ² = 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; I ² = 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; I ² = 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.

Keywords: COVID-19; Chronic anticoagulation; Mortality; Prehospital anticoagulation; Prior anticoagulation; Severity; Thromboembolic events.