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

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art_SHOLZBERG_Randomized_trials_of_therapeutic_heparin_for_COVID19_A_2021.PDF (1.48 MB)
Citações na Scopus
39
Tipo de produção
article
Data de publicação
2021
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
WILEY
Autores
SHOLZBERG, Michelle
COSTA, Bruno R. da
TANG, Grace H.
ALHAMZAH, Musaad
KREUZIGER, Lisa Baumann
AINLE, Fionnuala Ni
ALMARSHOODI, Mozah Obaid
JAMES, Paula D.
LILLICRAP, David
Citação
RESEARCH AND PRACTICE IN THROMBOSIS AND HAEMOSTASIS, v.5, n.8, article ID e12638, 9p, 2021
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background: 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.
Palavras-chave
anticoagulation, clinical trials, COVID-19, heparin, meta-analysis
URI
https://observatorio.fm.usp.br/handle/OPI/46178
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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