ABSTRACT
Anticoagulant therapy becomes critical to preventing further complications caused by the hypercoagulative state in COVID-19 patients. The optimal dose and time-dependent administration of anticoagulants for COVID-19 patients remains unknown. The purpose of this study was to determine the mortality and bleeding risks of anticoagulants administered based dose dependent and time-dependent manner for COVID-19 patients. We collected data from articles that compared prophylactic and therapeutic anticoagulants in COVID-19 patients recorded online from studies that were published around 2020 to 2021. We were obtained the articles from a scientific database such as ScienceDirect, Cochrane, ProQuest, PubMed, and Google Scholar based on the inclusion criteria. Data analysis was conducted using Review Manager Version 5.4.1. Based on time dependent-manner, therapeutic anticoagulant showed no benefit in reducing mortality (RR = 0.69;95% CI = 0.47 to 1.02). Beside, based on dose-dependent manner, prophylactic anticoagulant was found beneficial to prevent mortality (RR = 0.49;CI 95%;p = 0.02) compared to therapeutic. Therapeutic anticoagulants also showed higher risk of bleeding (RR = 0.27;CI 95%;p < 0.000001) compared to prophylactic. Therapeutic have no significantly benefit over prophylactic dose in reducing mortality rates. Therapeutic anticoagulant has a higher risk of bleeding in patients with COVID-19. Administer prophylactic dose is recommended due to the fewer side effects compared to the therapeutic dose.
ABSTRACT
BACKGROUND: Anticoagulant therapy is recommendation for COVID-19 infection. However, the mechanical ventilation needed for COVID-19 is still high. AIM: The aim of the study was to determine comparison therapeutic and prophylactic dose LMWH for mechanical necessity in COVID-19 infection. METHODS: A systematic literature search articles online from studies published between 2020 and 2021 that met our inclusion criteria and were retrieved from scientific databases such as Cochrane, ProQuest, and PubMed. The primary measure was a composite bad outcome, which included mechanical ventilation, mortality. and bleeding risk. RESULTS: There were 3432 patients from seven study included in this meta-analysis for necessity of mechanical ventilation in COVID-19 patients that used prophylactic and therapeutic anticoagulants. Prophylactic dose of anticoagulant showed no difference for the need for mechanical ventilation necessity for COVID-19 patients (RR = 0.54;95% CI = 0.20–1.48;p = 0.23). However, prophylactic anticoagulant showed more safe for bleeding incidence (RR = 0.27;95% CI = 0.18–0.39;p = <0.00001) and reduce mortality (RR = 0.52;95% CI = 0.46-0.58;p = <0.00001). CONCLUSION: LMWH anticoagulant dose not associated with reduce mechanical ventilation necessity but prophylactic dose prefers rather than therapeutic dose for reduce mortality and risk of bleeding.