Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Oomiya-ku, Saitama-shi, Saitama, 330-8503, Japan.
Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center (CTR), 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Infection. 2022 Dec;50(6):1453-1463. doi: 10.1007/s15010-022-01809-8. Epub 2022 Mar 30.
As no reported randomized control trials (RCTs) directly compare the three administration doses of anticoagulants (prophylactic dose, treatment dose, and no treatment), the most recommended dose to be administered to patients with coronavirus disease 2019 (COVID-19) remains unclear. The purpose of this study was to examine the effects of anticoagulant doses administered to patients with COVID-19, using a network meta-analysis (NMA) including high-quality studies.
All eligible trials from the Cochrane Central Register of Controlled Trials, MEDLINE, and Clinicaltrials.gov were included. We included RCTs and observational studies adjusted for covariates for patients aged ≥ 18 years and hospitalized due to objectively confirmed COVID-19. The main study outcome was mortality.
In patients with moderate COVID-19, the prophylactic (relative risk (RR) 0.64 [95% confidence interval (CI) 0.52-0.80]) and treatment dose (RR 0.57 [95% CI 0.45-0.72] were associated with a lower risk of short-term mortality than that with no anticoagulant treatment. However, the prophylactic and treatment dose groups were not significantly different. The hierarchy for efficacy in reducing short-term mortality was treatment dose (P score 92.4) > prophylactic dose (57.6) > no treatment (0.0). In patients with severe COVID-19, due to the absence of trials with the no-treatment group, NMA could not be conducted. However, pairwise comparison did not show a significant difference between the prophylactic and treatment dose groups.
Treatment and prophylactic doses of anticoagulants showed similar effects on mortality; however, the treatment dose is preferred over the prophylactic dose for patients with both moderate and severe COVID-19.
PROSPERO (registration number: CRD42021245308, 05/21/2021).
由于没有直接比较三种抗凝剂给药剂量（预防剂量、治疗剂量和无治疗）的随机对照试验（RCT），因此对于 2019 年冠状病毒病（COVID-19）患者应给予的最推荐剂量仍不清楚。本研究旨在通过包含高质量研究的网络荟萃分析（NMA）来检验 COVID-19 患者给予抗凝剂剂量的效果。
纳入 Cochrane 对照试验中心注册库、MEDLINE 和 Clinicaltrials.gov 中的所有合格试验。纳入 RCT 和调整了协变量的观察性研究，研究对象为年龄≥18 岁且因客观证实的 COVID-19 住院的患者。主要研究结局为死亡率。
在中度 COVID-19 患者中，与无抗凝治疗相比，预防剂量（RR 0.64 [95%置信区间（CI）0.52-0.80]）和治疗剂量（RR 0.57 [95% CI 0.45-0.72]）与短期死亡率降低相关。然而，预防剂量组和治疗剂量组之间没有显著差异。降低短期死亡率的疗效等级为治疗剂量（P 评分 92.4）>预防剂量（57.6）>无治疗（0.0）。在严重 COVID-19 患者中，由于缺乏无治疗组的试验，无法进行 NMA。然而，两两比较显示预防剂量组和治疗剂量组之间没有显著差异。
抗凝治疗剂量和预防剂量对死亡率的影响相似；然而，对于中重度 COVID-19 患者，治疗剂量优于预防剂量。
PROSPERO（注册号：CRD42021245308，2021 年 5 月 21 日）。
