Alhawiti Naif M, Alhawiti Jamal M, Alshalan Saif D, Alotaibi Badi A, Khobrani Ahmad Y
Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Kingdom of Saudi Arabia.
King Abdullah International Medical Research Center (KAIMRC), Riyadh, Kingdom of Saudi Arabia.
Infect Drug Resist. 2023 Jun 14;16:3767-3775. doi: 10.2147/IDR.S410374. eCollection 2023.
The COVID-19 infection caused by SARS-CoV-2 is a healthcare crisis that has led to unparalleled disruption and has impacted healthcare services, leading to significant morbidity and mortality in the worldwide population. Insufficient data on the management of COVID-19 complications such as hypercoagulability and the controversy about the benefits of anticoagulant therapy are major challenges encountered by clinicians, especially for patients with pre-existing cardiovascular diseases (CVD), and are still debatable. Therefore, we endeavored to conduct a systematic review to assess the clinical outcomes of prior anticoagulant therapy in patients with COVID-19 having pre-existing CVD. Electronic searches of the PubMed database and EBSCO Information Services were carried out, and all relevant articles were employed. Seven articles with data from 21,989 subjects were included. Despite the promised clinical outcomes of anticoagulant therapy, the results of the current systematic review indicated insignificant improvements in the reduction of mortality rate or ICU admission among patients with COVID-19 having pre-existing CVD. Furthermore, direct oral anticoagulant (DOAC) were favored over vitamin K antagonists (VKAs) due to better action and less side effects. In conclusion, the findings are controversial as we did not statistically analyze the results. The data showed inconsistent information with no clear effect of anticoagulant use before patient hospitalization or decreasing COVID-19 severity, particularly in those with CVD. Further studies including randomized controlled trials are required to describe the best course as well as optimal dose of anticoagulant use in the treatment of patients with COVID-19, particularly those with comorbidities such as CVD.
由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的2019冠状病毒病感染是一场医疗危机，导致了前所未有的混乱，并影响了医疗服务，在全球人口中造成了重大的发病率和死亡率。关于2019冠状病毒病并发症（如高凝状态）管理的数据不足以及抗凝治疗益处的争议是临床医生面临的主要挑战，尤其是对于已有心血管疾病（CVD）的患者，并且仍存在争议。因此，我们努力进行一项系统评价，以评估在已有CVD的2019冠状病毒病患者中预先进行抗凝治疗的临床结局。我们对PubMed数据库和EBSCO信息服务进行了电子检索，并纳入了所有相关文章。纳入了7篇包含来自21989名受试者数据的文章。尽管抗凝治疗有预期的临床结局，但当前系统评价的结果表明，在已有CVD的2019冠状病毒病患者中，死亡率降低或入住重症监护病房（ICU）方面并无显著改善。此外，由于作用更好且副作用更少，直接口服抗凝剂（DOAC）比维生素K拮抗剂（VKA）更受青睐。总之，由于我们未对结果进行统计学分析，研究结果存在争议。数据显示信息不一致，在患者住院前使用抗凝剂或降低2019冠状病毒病严重程度方面没有明确效果，尤其是在患有CVD的患者中。需要进一步的研究，包括随机对照试验，以描述在治疗2019冠状病毒病患者，特别是患有CVD等合并症的患者时，抗凝剂使用的最佳方案和最佳剂量。
