Infection and Drug Resistance (Jun 2023)
Clinical Outcomes of Anticoagulant Therapy in COVID-19 Patients with Pre-Existing Cardiovascular Diseases: A Systematic Review
Abstract
Naif M Alhawiti,1,2 Jamal M Alhawiti,3 Saif D Alshalan,3 Badi A Alotaibi,1,2 Ahmad Y Khobrani4 1Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Kingdom of Saudi Arabia; 2King Abdullah International Medical Research Center (KAIMRC), Riyadh, Kingdom of Saudi Arabia; 3College of Medicine, Al Jouf University, Riyadh, Kingdom of Saudi Arabia; 4Emergency Department, King Abdullah Bin Abdulaziz University Hospital, Princess Norah University, Riyadh, Kingdom of Saudi ArabiaCorrespondence: Naif M Alhawiti, Associate Professor and Consultant of Hematology, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia, Tel +11-4299999 Ext. 95139, Email [email protected]; [email protected]: 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.Keywords: COVID-19, anticoagulant, comorbidities, thrombosis
