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Iqbal K, Banga A, Arif TB, Rathore SS, Bhurwal A, Naqvi SKB, Mehdi M, Kumar P, Salklan MM, Iqbal A, Ahmed J, Sharma N, Lal A, Kashyap R, Bansal V, Domecq JP. 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; 14:92983. [DOI: 10.5662/wjm.v14.i3.92983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/24/2024] [Accepted: 05/11/2024] [Indexed: 06/25/2024] Open
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; 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.
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Affiliation(s)
- Kinza Iqbal
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
| | - Akshat Banga
- Department of Internal Medicine, Sawai Man Singh Medical College, Jaipur 302004, India
| | - Taha Bin Arif
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
| | - 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
| | | | - Muhammad Mehdi
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
| | - Pankaj Kumar
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
| | - Mitali Madhu Salklan
- Department of Internal Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak 124001, Haryana, India
| | - Ayman Iqbal
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
| | - Jawad Ahmed
- Department of Internal Medicine, Dow Medical College, Karachi 74200, Pakistan
| | - Nikhil Sharma
- 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
| | - Vikas Bansal
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States
| | - Juan Pablo Domecq
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, United States
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Zapata-Cachafeiro M, Prieto-Campo Á, Portela-Romero M, Carracedo-Martínez E, Lema-Oreiro M, Piñeiro-Lamas M, Chaudhuri S, Salgado-Barreira Á, Figueiras A. Effect of Previous Anticoagulant Treatment on Risk of COVID-19. Drug Saf 2023; 46:273-281. [PMID: 36562942 PMCID: PMC9782265 DOI: 10.1007/s40264-022-01266-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Little is known about the role played by anticoagulants in COVID-19. OBJECTIVE The aim of this study was to assess the impact of previous anticoagulant treatment on risk of hospitalization due to COVID-19, progression to severe COVID-19 and susceptibility to COVID-19 infection. METHODS We conducted a multiple population-based case-control study in northwest Spain, in 2020, to assess (1) risk of hospitalization: cases were all patients admitted due to COVID-19 with PCR confirmation, and controls were a random matched sample of subjects without a positive PCR; (2) progression: cases were hospitalized COVID-19 subjects, and controls were all non-hospitalized COVID-19 patients; and (3) susceptibility: cases were patients with a positive PCR (hospitalized and non-hospitalized), and the controls were the same as for the hospitalization model. Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using a generalized linear mixed model. RESULTS The consumption of antivitamin K and direct-acting anticoagulants apparently was not associated with the risk of progression to severe COVID-19 (OR 0.93 [95% CI 0.74-1.17] and OR 1.04 [95% CI 0.79-1.36], respectively). Antivitamin K anticoagulants were associated with a significantly lower risk of hospitalization (OR 0.77 [95% CI 0.64-0.93]), which, in part, can be explained by a decreased risk of susceptibility to infection (OR 0.83 [95% CI 0.74-0.92]). The use of direct-acting anticoagulants was not associated with the risk of hospitalization, although it also seems to decrease susceptibility (OR 0.85 [95% CI 0.74-0.98]). It has also been observed that low-molecular-weight heparins were associated with an increased risk of progression to severe COVID-19 (OR 1.25 [95% CI 1.01-1.55]). CONCLUSION The results of this study have shown that antivitamin K anticoagulants and direct-acting anticoagulants do not increase the risk of progression to more severe stages. Antivitamin K consumption was associated with a lower risk of hospitalization and susceptibility to infection.
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Affiliation(s)
- Maruxa Zapata-Cachafeiro
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health, (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain
- Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Ángela Prieto-Campo
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Manuel Portela-Romero
- Centro de Salud Concepción Arenal, Santiago de Compostela, A Coruña, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, Spain
| | - Eduardo Carracedo-Martínez
- Santiago de Compostela Health Area, Galician Health Service (Servizo Galego de Saúde-SERGAS), Santiago de Compostela, Spain
| | - Martina Lema-Oreiro
- Pharmaceutical Provision Management Service, Galician Health Service, Santiago de Compostela, Spain
| | - María Piñeiro-Lamas
- Consortium for Biomedical Research in Epidemiology and Public Health, (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain
- Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Somnath Chaudhuri
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ángel Salgado-Barreira
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health, (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain.
- Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - Adolfo Figueiras
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health, (CIBER en Epidemiología y Salud Pública-CIBERESP), Santiago de Compostela, Spain
- Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Nadeem A, Ejaz Z. Comment on "Pre-hospital antiplatelet medication use on COVID-19 disease severity". Heart Lung 2022; 55:164-165. [PMID: 35537878 PMCID: PMC9058136 DOI: 10.1016/j.hrtlng.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Arsalan Nadeem
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan.
| | - Zoya Ejaz
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan.
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Bouchlarhem A, Boulouiz S, El Aidouni G, Bkiyar H, Bazid Z, Ismaili N, Housni B, El Ouafi N. The Impact of Prior Antithrombotic use on Thromboembolic Events in Patients with Cardiovascular Disease and Severe COVID-19 Infection. Clin Appl Thromb Hemost 2022; 28:10760296221141449. [PMID: 36514250 DOI: 10.1177/10760296221141449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Our objective in this study was to determine the predictive factors of thromboembolic complications in patients with previous heart disease and severe covid-19 infection and the impact of previous use of antithrombotics on protection against these complications. METHODS We conducted a single-center retrospective study of 158 patients with heart disease admitted to an intensive care unit for severe SARS-COV-2 infection. In order to determine the predictive factors, we used logistic regression analysis. RESULTS Out of 158 patients, 22 were complicated by a thrombo-embolic event (13.9%), mean age of our population 64.03 (SD = 15.27), with a male predominance of 98 (62%). For the predictive factors of thromboembolic complications, and after multivariate analysis, we find the short duration of hospitalization (OR = 0.92; 95%CI (0.863-0.983), P = .014, previous use of antithrombotic drugs ((OR = 0.288, 95%CI (0.091-0.911), P = .034 for antiplatelet agents) and (OR = 0.322, 95% CI (0, 131-0.851), P = .021) for anticoagulants) as protective factors, and admission thrombocytosis as a risk factor (OR = 4.58, 95%CI (1.2-10.627), P = .021). D-dimer was not detected as a risk factor, and this can be explained by the characteristics of our population. Although prior use of antithrombotic drugs protects against thromboembolic complications during severe infection, there was no benefit in mortality. CONCLUSION Prior use of antithrombotic drugs is a protective factor against thromboembolic complications in patients with a history of heart disease but without effect on mortality.
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Affiliation(s)
- Amine Bouchlarhem
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Cardiology, Mohammed VI University Hospital Mohammed I University Oujda, Oujda, Morocco
| | - Soumia Boulouiz
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Cardiology, Mohammed VI University Hospital Mohammed I University Oujda, Oujda, Morocco
| | - Ghizlane El Aidouni
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Intensive Care unit, Mohammed VI University Hospital Mohammed I University Oujda, Oujda, Morocco
| | - Houssam Bkiyar
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Intensive Care unit, Mohammed VI University Hospital Mohammed I University Oujda, Oujda, Morocco
| | - Zakaria Bazid
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Cardiology, Mohammed VI University Hospital Mohammed I University Oujda, Oujda, Morocco
| | - Nabila Ismaili
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Cardiology, Mohammed VI University Hospital Mohammed I University Oujda, Oujda, Morocco
| | - Brahim Housni
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Intensive Care unit, Mohammed VI University Hospital Mohammed I University Oujda, Oujda, Morocco
| | - Noha El Ouafi
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Cardiology, Mohammed VI University Hospital Mohammed I University Oujda, Oujda, Morocco.,Department of Epidemiology, Mohammed VI University Hospital Mohammed I University Oujda, Oujda, Morocco
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Vuorio A, Lassila R, Kovanen PT. Hypercholesterolemia and COVID-19: Statins for Lowering the Risk of Venous Thromboembolism. Front Cardiovasc Med 2021; 8:711923. [PMID: 34722654 PMCID: PMC8548371 DOI: 10.3389/fcvm.2021.711923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/09/2021] [Indexed: 12/22/2022] Open
Affiliation(s)
- Alpo Vuorio
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.,Mehiläinen Airport Health Centre, Vantaa, Finland
| | - Riitta Lassila
- Research Program Unit in Systems Oncology, Coagulation Disorders Unit, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Petri T Kovanen
- Wihuri Research Institute, Biomedicum Helsinki 1, Helsinki, Finland
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