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Thromboprophylaxis for outpatients with COVID-19: a Systematic Review and Meta-analysis

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Abstract

Patients with COVID-19 develop an increased risk of thromboembolism. Thromboprophylaxis is recommended for hospitalized COVID-19 patients, but the role of thromboprophylaxis in outpatients with COVID-19 is less well defined. We conducted a systematic review and meta-analysis to evaluate the safety and efficacy of thromboprophylaxis among outpatients with COVID-19. We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from inception to August 2023. The outcomes of interest were venous thromboembolic events including deep venous thrombosis and pulmonary embolism, all-cause mortality, cardiovascular events, hospitalization, major bleeding events, and non-major bleeding events. We included 6 trials comprising 3352 patients. Patients who received thromboprophylaxis had an approximately 70% reduction in venous thromboembolism (RR, 0.28 [95% CI, 0.08 to 0.93]) compared to patients who did not receive thromboprophylaxis. The risk of mortality (RR, 0.79 [95% CI, 0.35 to 1.77]), cardiovascular events (RR, 0.91 [95% CI, 0.30 to 2.73]), and hospitalization (RR, 1.09 [95% CI, 0.81 to 1.47]) were similar between the two groups. Patients who received thromboprophylaxis had a higher risk of non-major bleeding (RR, 3.48 [95% CI, 1.72 to 7.05) compared to patients who did not receive thromboprophylaxis. Thromboprophylaxis reduced the risk of venous thromboembolism but not mortality, cardiovascular events, or hospitalization among outpatients with COVID-19.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article or its supplementary materials. The template data collection forms and data used for all analyses including the analytic code can be obtained upon reasonable request from the corresponding author.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA

    Cho-Han Chiang

  2. Department of Medicine, Unity Hospital, Rochester Regional Health, Rochester, NY, USA

    Omer Ahmed & Xin Ya See

  3. Department of Medicine, Yale New Haven Hospital, New Haven, CT, USA

    Weitao Liu

  4. Department of Medicine, Danbury Hospital, Danbury, CT, USA

    Yu-Cheng Chang & Chun-Yu Peng

  5. Harvard Graduate School of Education, Cambridge, MA, USA

    Zihan Wang

  6. Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Cho-Hsien Chiang

  7. School of Hygiene & Tropical Medicine, London, UK

    Cho-Hsien Chiang

  8. Department of Family Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Foundation, New Taipei City, Taiwan

    Yuan Ping Hsia

  9. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Cho-Hung Chiang

Authors
  1. Cho-Han Chiang
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  2. Omer Ahmed
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  3. Weitao Liu
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  4. Xin Ya See
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  5. Yu-Cheng Chang
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  6. Chun-Yu Peng
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  7. Zihan Wang
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  8. Cho-Hsien Chiang
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  9. Yuan Ping Hsia
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  10. Cho-Hung Chiang
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Corresponding author

Correspondence to Yuan Ping Hsia.

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Key points

• The role of thromboprophylaxis among COVID-19 outpatients is unclear.

• We performed a systematic review and meta-analysis to evaluate the efficacy and safety of thromboprophylaxis among COVID-19 outpatients.

• Thromboprophylaxis reduces the risk of venous thromboembolism but not mortality, cardiovascular events, or hospitalization.

• Thromboprophylaxis increases the risk of non-major bleeding.

• The risk of non-major bleeding appears to be higher in patients receiving direct oral anticoagulants.

Supplementary Information

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Supplementary file1 (DOCX 520 KB)

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Chiang, CH., Ahmed, O., Liu, W. et al. Thromboprophylaxis for outpatients with COVID-19: a Systematic Review and Meta-analysis. J Thromb Thrombolysis (2024). https://doi.org/10.1007/s11239-024-02966-3

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  • DOI: https://doi.org/10.1007/s11239-024-02966-3

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