. Divisão de Pneumologia, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu (SP) Brasil.
. Medicina Baseada em Evidências, Associação Médica Brasileira, São Paulo (SP) Brasil.
J Bras Pneumol. 2022 Jun 6;48(4):e20220041. doi: 10.36416/1806-3756/e20220041. eCollection 2022.
To answer questions related to the use of anticoagulants in the treatment of COVID-19 patients.
This was a systematic review and meta-analysis of phase 3 randomized controlled trials comparing the use of anticoagulants in non-hospitalized and hospitalized COVID-19 patients. We searched the following databases: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from their inception to January 22, 2022. The risk of bias was assessed by the Cochrane risk-of-bias tool, and the quality of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation system.
A total of 401 studies were initially selected. Of those, 9 met the inclusion criteria and were therefore analyzed (a total of 6,004 patients being analyzed). In non-hospitalized COVID-19 patients, no significant difference was found between post-discharge prophylactic anticoagulation and no intervention regarding venous thromboembolism or bleeding at 30 days. In hospitalized COVID-19 patients, full anticoagulation resulted in a slight reduction in thrombotic events at 30 days (risk difference, -0.03; 95% CI, -0.06 to -0.00; p = 0.04; I2 = 78%), the quality of evidence being moderate. However, no significant difference was found between full anticoagulation and no intervention regarding the risk of major bleeding, the quality of evidence being very low. No significant difference was found between intermediate- and standard-dose prophylactic anticoagulation (risk difference, -0.01; 95% CI, -0.07 to 0.06; p = 0.81; I2 = 0%), the quality of evidence being very low.
Therapeutic anticoagulation appears to have no effect on mortality in COVID-19 patients, resulting in a slight reduction in venous thromboembolism in hospitalized patients.
回答与 COVID-19 患者抗凝治疗相关的问题。
这是一项关于比较非住院和住院 COVID-19 患者使用抗凝剂的 3 期随机对照试验的系统评价和荟萃分析。我们检索了以下数据库：MEDLINE、EMBASE、Cochrane 对照试验中心注册库和 ClinicalTrials.gov，检索时间从建库至 2022 年 1 月 22 日。使用 Cochrane 偏倚风险工具评估偏倚风险，使用推荐评估、制定与评价分级系统评估证据质量。
最初共选择了 401 项研究。其中，9 项符合纳入标准并因此进行了分析（共分析了 6004 例患者）。在非住院 COVID-19 患者中，出院后预防性抗凝与无干预在 30 天内静脉血栓栓塞或出血方面无显著差异。在住院 COVID-19 患者中，充分抗凝可使 30 天内血栓事件略有减少（风险差异，-0.03；95%CI，-0.06 至-0.00；p = 0.04；I2 = 78%），证据质量为中级。然而，充分抗凝与无干预在大出血风险方面无显著差异，证据质量为极低级。中剂量与标准剂量预防性抗凝之间也无显著差异（风险差异，-0.01；95%CI，-0.07 至 0.06；p = 0.81；I2 = 0%），证据质量为极低级。
治疗性抗凝似乎对 COVID-19 患者的死亡率没有影响，反而使住院患者的静脉血栓栓塞风险略有降低。
