COVID-19 thromboprophylaxis. New evidence.

Fecha de publicación: 06/09/2023 Fecha Ahead of Print: 06/09/2023

Autores de IIS La Fe

Raquel Ferrandis Comes

Autor

Participantes ajenos a IIS La Fe

Sierra P
Gomez-Luque A

Grupos

Anestesia y Cuidados Críticos

Investigador Principal

María Azucena Pajares Moncho
Medicina Perioperatoria, Anestesiología y Reanimación

Leader

Óscar Díaz Cambronero

Abstract

Recent publications have questioned the efficacy of using therapeutic or intermediate doses of low molecular weight heparin in COVID-19 patients, especially in the most severe patients. In order to update these recommendations, a non-systematic review has been carried out in the main medical databases. A total of 14 randomized clinical trials, 14 meta-analyses and the recommendations of 12 scientific societies were selected, stratified according to the type of patient (outpatient, hospitalized, admitted to critical care or post-discharge). The efficacy of heparin and other therapeutic approaches (rivaroxaban, apixaban, sulodexide, acetylsalicylic acid and P2Y12 inhibitors) has been analyzed. The findings recommend using standard doses of heparin as thromboprophylaxis in critically hospitalized COVID-19 patients and therapeutic doses in non-critically hospitalized patients if the risk of bleeding is low. In outpatients and those discharged from the hospital, heparin could be used at a prophylactic dose if there are thrombotic risk factors, and the bleeding risk is low. It is not recommended to associate antiplatelet agents with heparin unless previously indicated.