Randomized trials of therapeutic heparin for COVID-19: A meta-analysis

Página do item simplificado
dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorSHOLZBERG, Michelle
dc.contributor.authorCOSTA, Bruno R. da
dc.contributor.authorTANG, Grace H.
dc.contributor.authorRAHHAL, Hassan
dc.contributor.authorALHAMZAH, Musaad
dc.contributor.authorKREUZIGER, Lisa Baumann
dc.contributor.authorAINLE, Fionnuala Ni
dc.contributor.authorALMARSHOODI, Mozah Obaid
dc.contributor.authorJAMES, Paula D.
dc.contributor.authorLILLICRAP, David
dc.contributor.authorCARRIER, Marc
dc.contributor.authorBECKETT, Andrew
dc.contributor.authorFRALICK, Michael
dc.contributor.authorMIDDELDORP, Saskia
dc.contributor.authorLEE, Agnes Y. Y.
dc.contributor.authorTHORPE, Kevin E.
dc.contributor.authorNEGRI, Elnara Marcia
dc.contributor.authorCUSHMAN, Mary
dc.contributor.authorJUNI, Peter
dc.contributor.groupauthorRAPID Trial Investigators
dc.date.accessioned2022-04-19T13:07:02Z
dc.date.available2022-04-19T13:07:02Z
dc.date.issued2021
dc.description.abstractBackground: Pulmonary endothelial injury and microcirculatory thromboses likely contribute to hypoxemic respiratory failure, the most common cause of death, in patients with COVID-19. Randomized controlled trials (RCTs) suggest differences in the effect of therapeutic heparin between moderately and severely ill patients with COVID-19. We did a systematic review and meta-analysis of RCTs to determine the effects of therapeutic heparin in hospitalized patients with COVID-19. Methods: We searched PubMed, Embase, Web of Science, medRxiv, and medical conference proceedings for RCTs comparing therapeutic heparin with usual care, excluding trials that used oral anticoagulation or intermediate doses of heparin in the experimental arm, Mantel-Haenszel fixed-effect meta-analysis was used to combine odds ratios (ORs). Results and Conclusions: There were 3 RCTs that compared therapeutic heparin to lower doses of heparin in 2854 moderately ill ward patients, and 3 RCTs in 1191 severely ill patients receiving critical care. In moderately ill patients, there was a nonsignificant reduction in all-cause death (OR, 0.76; 95% CI, 0.57-1.02), but significant reductions in the composite of death or invasive mechanical ventilation (OR, 0.77; 95% CI, 0.60 0.98), and death or any thrombotic event (OR, 0.58; 95% CI, 0.45-0.77). Organ support-free days alive (OR, 1.29; 95% CI, 1.07-1.57) were significantly increased with therapeutic heparin. There was a nonsignificant increase in major bleeding. In severely ill patients, there was no evidence for benefit of therapeutic heparin, with significant treatment-by-subgroup interactions with illness severity for all-cause death (P = .034). In conclusion, therapeutic heparin is beneficial in moderately ill patients but not in severely ill patients hospitalized with COVID-19.eng
dc.description.indexPubMedeng
dc.description.sponsorshipDefense Research Development Canada, Department of National Defense, Ottawa, Canada
dc.identifier.citationRESEARCH AND PRACTICE IN THROMBOSIS AND HAEMOSTASIS, v.5, n.8, article ID e12638, 9p, 2021
dc.identifier.doi10.1002/rth2.12638
dc.identifier.eissn2475-0379
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/46178
dc.language.isoeng
dc.publisherWILEYeng
dc.relation.ispartofResearch and Practice in Thrombosis and Haemostasis
dc.rightsopenAccesseng
dc.rights.holderCopyright WILEYeng
dc.subjectanticoagulationeng
dc.subjectclinical trialseng
dc.subjectCOVID-19eng
dc.subjectheparineng
dc.subjectmeta-analysiseng
dc.subject.otherprophylactic anticoagulationeng
dc.subject.wosHematologyeng
dc.subject.wosPeripheral Vascular Diseaseeng
dc.titleRandomized trials of therapeutic heparin for COVID-19: A meta-analysiseng
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.affiliation.countryIrlanda
hcfmusp.affiliation.countryEmirados Árabes Unidos
hcfmusp.affiliation.countryCanadá
hcfmusp.affiliation.countryÁrabia Saudita
hcfmusp.affiliation.countryHolanda
hcfmusp.affiliation.countrySuíça
hcfmusp.affiliation.countryEstados Unidos
hcfmusp.affiliation.countryisoca
hcfmusp.affiliation.countryisoch
hcfmusp.affiliation.countryisosa
hcfmusp.affiliation.countryisous
hcfmusp.affiliation.countryisoie
hcfmusp.affiliation.countryisoae
hcfmusp.affiliation.countryisonl
hcfmusp.author.externalSHOLZBERG, Michelle:Univ Toronto, Li Ka Shing Knowledge Inst, St Michaels Hosp, Dept Med, Toronto, ON, Canada; Univ Toronto, Li Ka Shing Knowledge Inst, Dept Lab Med & Pathobiol, St Michaels Hosp, Toronto, ON, Canada
hcfmusp.author.externalCOSTA, Bruno R. da:Univ Toronto, Appl Hlth Res Ctr AHRC, Li Ka Shing Knowledge Inst, St Michaels Hosp, Toronto, ON, Canada; Univ Bern, Inst Primary Hlth Care BIHAM, Bern, Switzerland
hcfmusp.author.externalTANG, Grace H.:Univ Toronto, Hematol Oncol Clin Res Grp, St Michaels Hosp, Toronto, ON, Canada
hcfmusp.author.externalALHAMZAH, Musaad:King Saud Univ, Coll Med, Dept Surg, Riyadh, Saudi Arabia; King Saud Univ Med City, Div Vasc Surg, Riyadh, Saudi Arabia
hcfmusp.author.externalKREUZIGER, Lisa Baumann:Versiti, Med Coll Wisconsin, Milwaukee, WI USA
hcfmusp.author.externalAINLE, Fionnuala Ni:Mater Misericordiae Univ Hosp, Dublin, Ireland; Univ Coll Dublin, Sch Med, Dublin, Ireland; Irish Network Venous Thromboembolism Res, Dublin, Ireland
hcfmusp.author.externalALMARSHOODI, Mozah Obaid:Tawam Hosp, SEHA, Al Ain, U Arab Emirates
hcfmusp.author.externalJAMES, Paula D.:Queens Univ, Dept Med, Kingston, ON, Canada
hcfmusp.author.externalLILLICRAP, David:Queens Univ, Dept Pathol & Mol Med, Kingston, ON, Canada
hcfmusp.author.externalCARRIER, Marc:Univ Ottawa, Ottawa Hosp Res Inst, Dept Med, Ottawa, ON, Canada
hcfmusp.author.externalBECKETT, Andrew:Univ Toronto, St Michaels Hosp, Toronto, ON, Canada; Canadian Forces Hlth Serv, Ottawa, ON, Canada
hcfmusp.author.externalFRALICK, Michael:Univ Toronto, Sinai Hlth, Gen Internal Med, Toronto, ON, Canada
hcfmusp.author.externalMIDDELDORP, Saskia:Radboud Univ Nijmegen, Radboud Inst Hlth Sci RIHS, Dept Internal Med, Med Ctr, Nijmegen, Netherlands
hcfmusp.author.externalLEE, Agnes Y. Y.:Univ British Columbia, Vancouver Coastal Hlth Res Inst, Vancouver, BC, Canada
hcfmusp.author.externalTHORPE, Kevin E.:Univ Toronto, Appl Hlth Res Ctr, Dalla Lana Sch Publ Hlth, Li Ka Shing Knowledge Inst,St Michaels Hosp, Toronto, ON, Canada
hcfmusp.author.externalCUSHMAN, Mary:Univ Vermont, Dept Med, Med Ctr, Larner Coll Med, Burlington, VT USA
hcfmusp.author.externalJUNI, Peter:Univ Toronto, Appl Hlth Res Ctr, Li Ka Shing Knowledge Inst, Dept Med,St Michaels Hosp,Inst Hlth Policy Manage, Toronto, ON, Canada
hcfmusp.citation.scopus39
hcfmusp.contributor.author-fmusphcHASSAN RAHHAL
hcfmusp.contributor.author-fmusphcELNARA MARCIA NEGRI
hcfmusp.description.articlenumbere12638
hcfmusp.description.issue8
hcfmusp.description.volume5
hcfmusp.origemWOS
hcfmusp.origem.pubmed34977448
hcfmusp.origem.scopus2-s2.0-85122084631
hcfmusp.origem.wosWOS:000756485300014
hcfmusp.publisher.cityHOBOKENeng
hcfmusp.publisher.countryUSAeng
hcfmusp.relation.referenceLemos ACB, 2020, THROMB RES, V196, P359, DOI 10.1016/j.thromres.2020.09.026eng
hcfmusp.relation.referenceBikdeli B, 2020, THROMB RES, V196, P638, DOI 10.1016/j.thromres.2020.09.033eng
hcfmusp.relation.referenceBuijsers B, 2020, EBIOMEDICINE, V59, DOI 10.1016/j.ebiom.2020.102969eng
hcfmusp.relation.referenceClausen TM, 2020, CELL, V183, P1043, DOI [10.1016/j.cell.2020.09.033, 10.1101/2020.07.14.201616]eng
hcfmusp.relation.referenceda Costa BR, 2014, EUR HEART J, V35, P3336, DOI 10.1093/eurheartj/ehu424eng
hcfmusp.relation.referenceGoldin M, 2021, THROMB HAEMOSTASIS, V121, P1684, DOI 10.1055/a-1475-2351eng
hcfmusp.relation.referenceGordon AC, 2021, NEW ENGL J MED, V384, P1491, DOI 10.1056/NEJMoa2100433eng
hcfmusp.relation.referenceHouston BL, 2020, CLIN TRIALS, V17, P491, DOI 10.1177/1740774520943846eng
hcfmusp.relation.referenceIba T, 2020, CRIT CARE MED, V48, P1358, DOI 10.1097/CCM.0000000000004458eng
hcfmusp.relation.referenceLawler PR, 2021, NEW ENGL J MED, V385, P790, DOI 10.1056/NEJMoa2105911eng
hcfmusp.relation.referenceLopes RD, 2021, LANCET, V397, P2253, DOI 10.1016/S0140-6736(21)01203-4eng
hcfmusp.relation.referenceMcGonagle D, 2020, LANCET RHEUMATOL, V2, pE437, DOI 10.1016/S2665-9913(20)30121-1eng
hcfmusp.relation.referenceMycroft-West CJ, 2020, THROMB HAEMOSTASIS, V120, P1700, DOI 10.1055/s-0040-1721319eng
hcfmusp.relation.referenceNopp S, 2020, RES PRACT THROMB HAE, V4, P1178, DOI 10.1002/rth2.12439eng
hcfmusp.relation.referenceOrtega-Paz L., 2021, EUR HEART J-CARD IMGeng
hcfmusp.relation.referencePage Clive, 2013, ISRN Pharmacol, V2013, P910743, DOI 10.1155/2013/910743eng
hcfmusp.relation.referencePage MJ, 2021, PLOS MED, V18, DOI [10.1016/j.ijsu.2021.105906, 10.1371/journal.pmed.1003583]eng
hcfmusp.relation.referenceParanjpe I, 2020, J AM COLL CARDIOL, V76, P122, DOI 10.1016/j.jacc.2020.05.001eng
hcfmusp.relation.referencePerepu US, 2021, J THROMB HAEMOST, V19, P2225, DOI 10.1111/jth.15450eng
hcfmusp.relation.referencePoor HD, 2021, CHEST, V160, P1471, DOI 10.1016/j.chest.2021.06.016eng
hcfmusp.relation.referenceSadeghipour P, 2021, JAMA-J AM MED ASSOC, V325, P1620, DOI 10.1001/jama.2021.4152eng
hcfmusp.relation.referenceSchulman S, 2005, J THROMB HAEMOST, V3, P692, DOI 10.1111/j.1538-7836.2005.01204.xeng
hcfmusp.relation.referenceSholzberg M, 2021, BMJ-BRIT MED J, V375, DOI 10.1136/bmj.n2400eng
hcfmusp.relation.referenceSholzberg M, 2021, TRIALS, V22, DOI 10.1186/s13063-021-05076-0eng
hcfmusp.relation.referenceSpyropoulos AC, 2021, JAMA INTERN MED, V181, P1612, DOI 10.1001/jamainternmed.2021.6203eng
hcfmusp.relation.referenceSterne JAC, 2019, BMJ-BRIT MED J, V366, DOI 10.1136/bmj.l4898eng
hcfmusp.relation.referenceTang N, 2020, J THROMB HAEMOST, V18, P1094, DOI 10.1111/jth.14817eng
hcfmusp.relation.referenceten Cate H, 2021, NEW ENGL J MED, V385, P845, DOI 10.1056/NEJMe2111151eng
hcfmusp.relation.referenceTritschler T, 2020, J THROMB HAEMOST, V18, P2958, DOI 10.1111/jth.15094eng
hcfmusp.relation.referenceWHO Solidarity Trial Consortium, 2021, NEW ENGL J MED, V384, P497, DOI 10.1056/NEJMoa2023184eng
hcfmusp.relation.referenceZhou F, 2020, LANCET, V395, P1054, DOI 10.1016/S0140-6736(20)30566-3eng
hcfmusp.scopus.lastupdate2024-05-17
relation.isAuthorOfPublicationba4baa8d-ea7d-4fd2-986d-34ba112f11f0
relation.isAuthorOfPublicatione09378f2-b5d8-49bd-bd21-d6ed4b5979a0
relation.isAuthorOfPublication.latestForDiscoveryba4baa8d-ea7d-4fd2-986d-34ba112f11f0
Arquivos
Pacote Original
Agora exibindo 1 - 1 de 1
Imagem de Miniatura
Nome:
art_SHOLZBERG_Randomized_trials_of_therapeutic_heparin_for_COVID19_A_2021.PDF
Tamanho:
1.48 MB
Formato:
Adobe Portable Document Format
Descrição:
publishedVersion (English)
Baixar
Coleções
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - COVID-19
Artigos e Materiais de Revistas Científicas - LIM/59
Artigos e Materiais de Revistas Científicas - ODS/03