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COVID-19 rapid evidence review: reducing the risk of venous thromboembolism in over 16s. London: National Institute for Health and Care Excellence (NICE); 2020 Nov. (NICE Guideline, No. 186.)
COVID-19 rapid evidence review: reducing the risk of venous thromboembolism in over 16s.
Show detailsLiterature search
One systematic database search was conducted to cover both review questions considered in this guideline because only the setting differed across review questions. The search for evidence was undertaken by NICE’s information services team up to 19 October 2020. Studies were also considered from the NICE surveillance checks up to 27 October 2020.These search records were also subsequently assessed for inclusion (see appendix 4 for further details).
Results from the literature searches were screened using their titles and abstracts for relevance against the criteria from the protocol (see appendix 2). One reviewer undertook title and abstract screening with 10% checked by a second reviewer, and all studies requiring a second opinion were considered by a second reviewer.
Full text references of potentially relevant evidence were obtained and reviewed by one reviewer to determine whether they met the inclusion criteria for this evidence review. All full text eligibility decisions were checked by a second reviewer. All uncertainties in full text selection were discussed with a second reviewer and referred to an adviser if needed.
The Information services team conducted targeted searches for grey literature (e.g. guidelines, reports and statements) that included national and international sources. The searches were conducted on 12–13 October 2020. Grey literature sources were checked weekly during development, but no additional guidelines, reports or statements were found.
See appendix 4 for search and screening details and appendix 7 for the list of excluded studies, with reasons for exclusion.
Review question 2
What is the effectiveness and safety of pharmacological prophylaxis to reduce the risk of VTE in adults who have received care for COVID-19?
The review protocol is shown in appendix 2.
Included studies
No studies were included for review question 2. Instead, 11 guidelines (4 UK and 7 international guidelines) were identified through a search for guidelines on pharmacological prophylaxis to reduce the risk of VTE in adults who have received care for COVID-19. One of the guidelines was subsequently excluded because it was not published in English, leaving 10 guidelines for consideration.
See appendix 5 for a brief overview of included guidelines. More details are presented in appendix 6.
Key details
The 10 English-language guidelines were checked to determine whether they provided guidance on the effectiveness and safety of pharmacological prophylaxis to reduce the risk of VTE in adults who have received care for COVID-19. Overall:
- 7 of the 10 guidelines included a recommendation on the use of pharmacological prophylaxis to reduce the risk of VTE in adults who have received care for COVID-19
- All the recommendations were consensus based
- 6 of the 7 guidelines recommend ongoing thromboprophylaxis based on individual’s risk factors
- Recommended duration varied from 7 to 45 days
Strengths and limitations
The included guidelines were assessed using the AGREE II tool. The guidelines scored as either low or very low quality due to the lack of detailed methods for development provided, limited stakeholder involvement and lack of editorial independence.
Expert panel discussion
This section describes how the expert panel considered the evidence in relation to the recommendations within the guidance.
COVID-19 rapid guideline: reducing the risk of venous thromboembolism in over 16s
Relative value of different outcomes
No primary evidence was identified for this review question, so the relative value of different outcomes was not explicitly discussed.
Quality of the evidence
No evidence was identified for this review question, so the quality of evidence was not explicitly discussed. However, to provide some background context, the panel were presented with details of recommendations that four UK and 3 international guidelines provide in this area. The quality of the guidelines ranged from low to very low as assessed using the AGREE II tool.
Recommendations were developed by informal consensus.
The panel noted that from their clinical experience and their awareness of epidemiological studies that the rates of VTE in patients with COVID-19 who have been discharged from hospital are low. Several of these studies were in the context of not providing post-discharge thromboprophylaxis. However, the evidence appears to be conflicting and it was noted that an in-progress UK study is expected to report a higher VTE rate post-discharge in patients hospitalised with COVID-19 compared with post-discharge VTE rates reported in other studies.
The panel noted that NICE’s guideline on reducing the risk of hospital-acquired venous thromboembolism in over 16s (NICE guideline NG89) recommends that acutely ill medical patients receive thromboprophylaxis for a minimum of 7 days and may be discharged with VTE prophylaxis if they are discharged before completing their hospital course. On the basis of no evidence specific for patients with COVID-19, the panel considered this guidance was appropriate for this patient group too and would enable flexibility to prescribe a longer duration of prophylaxis if considered appropriate for the patient.
The panel discussed which type of prophylaxis should be offered noting, in their clinical experience, that LMWH may have less risk of interfering with antiviral medication. Additionally, LMWH is the first-line prophylaxis recommended in NG89 and no evidence was identified to suggest a different anticoagulant should be offered in patients discharged after treatment for COVID-19.
The panel noted that patients should be given information about continuing with thromboprophylaxis when being discharged after an inpatient stay for COVID-19. The panel agreed that provision of information for patients is important. However, the panel noted that the main message is to inform patients about risks of thromboprophylaxis in line with NICE’s guideline on reducing the risk of hospital-acquired venous thromboembolism in over 16s (NICE guideline NG89).
The lack of identified studies which included prespecified subgroups meant that the panel were unable to make recommendations on thromboprophylaxis post-discharge following treatment for COVID-19 for:
- People receiving treatment with sex hormones.
- People who have or have previously had cancer.
- People receiving renal replacement therapy or extracorporeal membrane oxygenation.
- People with clotting conditions or a history of venous thromboembolism.
- People with obesity (BMI 30 kg/m2 or higher).
It was noted that these subgroups should be managed on a case-by-case basis.
For women with COVID-19 who are pregnant or have given birth within the past 6 weeks, the panel agreed that clinicians should follow the advice on venous thromboembolism prevention in the Royal College of Obstetricians and Gynaecologists guidance on coronavirus (COVID-19) in pregnancy.
Due to the lack of evidence, the panel considered it important that the guideline recommends patients have the opportunity to be recruited to available trials to inform future recommendations in this area.
Trade-off between benefits and harms
The panel recognised that patients may require different lengths of thromboprophylaxis post-discharge depending on how long they have been in hospital. For this reason, the panel indicated the importance of ensuring that patients who will be completing pharmacological VTE prophylaxis after discharge are able to use it correctly or have arrangements made for someone to help them.
Implementation and resource considerations
As the panel recommended that thromboprophylaxis post-discharge for patients that have received treatment for COVID-19 should be given in line with recommendations in NICE’s guideline on reducing the risk of hospital-acquired venous thromboembolism in over 16s (NICE guideline NG89), they considered that there were no additional implementation considerations.
The panel noted past shortages of low molecular weight heparin products, although no current supply problems were identified.
Equality issues
In developing the scope of the guideline we identified the following equality issues which were addressed when developing the recommendations.
Religion / beliefs
Some pharmacological treatments for venous thromboembolism are derived from animal origin (heparins are of animal origin, and apixaban and rivaroxaban contain lactose from cow’s milk). People who have concerns about using animal products because of a religious or ethical belief need to be given consideration when discussing venous thromboembolism prophylaxis.
The guideline includes a recommendation for clinicians to be aware that heparins are of animal origin and cross refers to the section on giving information and planning for discharge in the NICE guideline on venous thromboembolism in over 16s for further information.
Disability
Some disabled people may have communication needs that need to be considered when using alternatives to face-to-face contact and also when facial masks are worn when receiving care.
The guideline overview section includes the following standard text that is considered to address equality issues regarding disability: ‘When using this guideline, follow the usual professional guidelines, standards and laws (including those on equalities, safeguarding, communication and mental capacity), as described in making decisions using NICE guidelines.’
Other considerations
No other considerations were raised in the discussions.
Appendix 1. Methods used to develop the guidance
Methods used to develop this guideline can be found in Developing NICE guidelines: the manual. Appendix L: Interim process and methods for guidelines developed in response to health and social care emergencies
Appendix 2. Review protocol
Review question 2. What is the effectiveness and safety of pharmacological prophylaxis to reduce the risk of VTE in adults who have received care for COVID-19?
PICO and eligibility criteria
| Criteria | Notes |
|---|---|
| Population | Adults (aged 16 years and older) who have had treatment for COVID-19 |
| Interventions | Pharmacological prophylaxis with: Direct oral anticoagulants (DOACs) Low molecular weight heparin Unfractionated heparin Fondaparinux sodium |
| Comparators | To each other Placebo / no treatment |
| Outcomes | Incidence of venous thromboembolism (VTE, PE, DVT) Mortality (all-cause mortality, inpatient mortality, COVID-related mortality) Admission to critical care (including use of advanced organ support) Serious adverse effects (such as major bleeding or admission to hospital) |
| Settings | All |
| Subgroups | Subgroups of people potentially at higher risk of thromboembolism include: Pregnant women People receiving treatment with sex hormones People who have or have previously had cancer People receiving renal replacement therapy or extracorporeal membrane oxygenation People with clotting conditions or a history of thromboembolism People with obesity (BMI 30kg/m2 or higher) |
| Study types | RCTs Cohort studies with a comparator group Systematic reviews of RCTs and/or cohort studies Depending on the volume of evidence identified, we may prioritise inclusion based on study design. We will prioritise inclusion of RCTs and systematic reviews of RCTs but if this study type is not available we will consider cohort studies with a comparator group and appropriate adjustment for confounding variables. |
| Countries | Any |
| Timepoints | Any |
| Other exclusions | Studies without a comparator group |
| Equality issues | Religion or beliefs, people with a learning disability and disabled people. |
Appendix 3. Literature search strategy
One search was carried out for both review questions:
Review question 1: What is the effectiveness and safety of pharmacological prophylaxis to reduce the risk of VTE in adults receiving care for suspected or confirmed COVID-19?
Review question 2: What is the effectiveness and safety of pharmacological prophylaxis to reduce the risk of VTE in adults who have received care for COVID-19?
Table 1Search strategy for the review questions
| Database | Platform | Segment searched |
|---|---|---|
| MEDLINE ALL | Ovid | 1946 to October 16, 2020 |
| Embase | Ovid | 1974 to 2020 October 15 |
| Cochrane Library | Wiley | Issue 10 of 12, October 2020 |
| Pre-prints – bioRxiv and medRxiv | RIS via EPPI | RIS file received on 19/10/2020, 8:32 AM |
| WHO COVID-19 database | WHO website | 19/10/2020 |
| Surveillance | - | 23 oct 2020 12:38 last modified Search date: 27th October |
Database strategies
Full details are available on request.
Table 2World Health Organization COVID-19 database strategy
| Variable | Details |
|---|---|
| Name | World Health Organization Global research on coronavirus disease (COVID-19) |
| URL |
https://www |
| Notes | "WHO is gathering the latest scientific findings and knowledge on coronavirus disease (COVID-19) and compiling it in a database. We update the database daily from searches of bibliographic databases, hand searches of the table of contents of relevant journals, and the addition of other relevant scientific articles that come to our attention." |
| Search terms | (tw:(anticoagula* OR antithromb* OR antiemboli* or thrombin* OR thromboprophyla* OR fibrinolytic* OR DOAC OR DOACs)) AND (tw:(thrombosis OR thromboses OR thrombus OR thromboembolism OR VTE OR DVT)) (tw:(apixaban OR eliquis OR rivaroxaban OR xarelto OR edoxaban OR lixiana OR savaysa OR fondaparinux OR arixtra OR aspirin OR acetylsalicylic)) (tw:(warfarin OR marevan OR acenocoumarol OR nicoumalone OR sinthrome OR phenindione OR dicumarol OR phenprocoumon OR biscoumacetate)) |
| How the results were selected | Searched terms and selected relevant ones from the list |
| Results | 125 – added to EPPI |
Appendix 4. Search and screening information
Evidence selection to completion of draft evidence review (26 October 2020) for expert panel meeting 2
| Stage | Number of references |
|---|---|
| Included for screening after deduplication and reference clean up | 321 |
| Included from title and abstract screening | 82 |
| Included from full text screening | 0 |
| Included from surveillance search after full text screening | 0 |
| Total included studies | 0 |
Appendix 5. Included studies
No studies were included for review question 2.
Instead 10 English-language guidelines were identified which provided guidance on the effectiveness and safety of pharmacological prophylaxis to reduce the risk of VTE in adults who have received care for COVID-19. Seven of the 10 guidelines (4 UK and 3 international guidelines) included recommendations on pharmacological prophylaxis to reduce the risk of VTE in adults who have received care for COVID-19 (post-discharge prophylaxis).
Review question 2. What is the effectiveness and safety of pharmacological prophylaxis to reduce the risk of VTE in adults who have received care for COVID-19?
Appendix 6. Evidence tables
Appendix 7. Excluded studies
Review question 2. What is the effectiveness and safety of pharmacological prophylaxis to reduce the risk of VTE in adults who have received care for COVID-19?
| Study | Reason for exclusion |
|---|---|
| Ayerbe, L.; Risco, C.; Ayis, S. (2020) The association between treatment with heparin and survival in patients with Covid-19. Journal of Thrombosis and Thrombolysis 50(2): 298–301 [PMC free article: PMC7261349] [PubMed: 32476080] | - Exclude - duplicate content |
| Ayerbe, Luis; Risco, Carlos; Ayis, Salma The association between treatment with heparin and survival in patients with Covid-19. medrxiv preprint [PMC free article: PMC7261349] [PubMed: 32476080] | - Exclude - duplicate content |
| Belen-Apak, F Burcu and Sarialioglu, F (2020) Pulmonary intravascular coagulation in COVID-19: possible pathogenesis and recommendations on anticoagulant/thrombolytic therapy. J Thromb Thrombolysis 50(2): 278–280 [PMC free article: PMC7200048] [PubMed: 32372336] | - Exclude - Not a study design specified in protocol |
| Belcaro, Gianni, Corsi, Marcello, Agus, Giovanni B et al. (2020) Thrombo-prophylaxis prevents thrombotic events in home-managed COVID patients. A registry study. Minerva medica 111(4): 366–368 [PubMed: 33032396] | - Exclude - surveillance study that would be excluded by development search filters |
| Beun, Robert, Kusadasi, Nuray, Sikma, Maaike et al. (2020) Thromboembolic events and apparent heparin resistance in patients infected with SARS-CoV-2. International journal of laboratory hematology 42suppl1: 19–20 [PMC free article: PMC7264532] [PubMed: 32311843] | - Exclude - Not a study design specified in protocol |
| Bikdeli, Behnood, Talasaz, Azita H, Rashidi, Farid et al. (2020) Intermediate versus standard-dose prophylactic anticoagulation and statin therapy versus placebo in critically-ill patients with COVID-19: Rationale and design of the INSPIRATION/INSPIRATION-S studies. Thrombosis research 196: 382–394 [PMC free article: PMC7513771] [PubMed: 32992075] | - Exclude - Not a study design specified in protocol |
| Birkeland, Kade, Zimmer, Raymond, Kimchi, Asher et al. (2020) Venous Thromboembolism in Hospitalized COVID-19 Patients: Systematic Review. Interactive journal of medical research 9(3): e22768 [PMC free article: PMC7473765] [PubMed: 32805702] | - Exclude - systematic review of non-controlled studies |
| Bompard, Florian, Monnier, Hippolyte, Saab, Ines et al. (2020) Pulmonary embolism in patients with COVID-19 pneumonia. The European respiratory journal 56(1) [PMC free article: PMC7236820] [PubMed: 32398297] | - Exclude - Not a study design specified in protocol |
| Brouns, Steffie H, Bruggemann, Renee, Linkens, Aimee E M J H et al. (2020) Mortality and the Use of Antithrombotic Therapies Among Nursing Home Residents with COVID-19. Journal of the American Geriatrics Society 68(8): 1647–1652 [PMC free article: PMC7361386] [PubMed: 32633418] | - Exclude - Not a study design specified in protocol (case series) |
| Cattaneo, Marco, Bertinato, Elena M, Birocchi, Simone et al. (2020) Pulmonary Embolism or Pulmonary Thrombosis in COVID-19? Is the Recommendation to Use High-Dose Heparin for Thromboprophylaxis Justified?. Thromb Haemost 120(8): 1230–1232 [PMC free article: PMC7516356] [PubMed: 32349132] | - Exclude - Not a study design specified in protocol |
| Cattaneo, Marco and Morici, Nuccia (2020) Is thromboprophylaxis with high-dose enoxaparin really necessary for COVID-19 patients? A new “prudent” randomised clinical trial. Blood transfusion = Trasfusione del sangue 18(3): 237–238 [PMC free article: PMC7250693] [PubMed: 32453692] | - Exclude - Not a study design specified in protocol |
| Chang, Heepeel, Rockman, Caron B, Jacobowitz, Glenn R et al. (2020) Deep Venous Thrombosis in Hospitalized Patients with Coronavirus Disease 2019. Journal of vascular surgery. Venous and lymphatic disorders | - Exclude - Not a study design specified in protocol |
| Chi, Gerald, Lee, Jane J, Jamil, Adeel et al. (2020) Venous Thromboembolism among Hospitalized Patients with COVID-19 Undergoing Thromboprophylaxis: A Systematic Review and Meta-Analysis. Journal of clinical medicine 9(8) [PMC free article: PMC7463975] [PubMed: 32756383] | - Exclude - Not a study design specified in protocol |
| Criel, M., Falter, M., Jaeken, J. et al. (2020) Venous thromboembolism in SARS-CoV-2 patients: Only a problem in ventilated ICU patients, or is there more to it?. European Respiratory Journal 56(1): 2001201 [PMC free article: PMC7236825] [PubMed: 32398294] | - Exclude - Not a study design specified in protocol |
| Daughety, Molly M., Morgan, Andrew, Frost, Erin et al. (2020) COVID-19 associated coagulopathy: Thrombosis, hemorrhage and mortality rates with an escalated-dose Thromboprophylaxis strategy. Thrombosis Research [PMC free article: PMC7557260] [PubMed: 33091700] | - Exclude - Not a study design specified in protocol |
| Di Minno, Alessandro, Ambrosino, Pasquale, Calcaterra, Ilenia et al. (2020) COVID-19 and Venous Thromboembolism: A Meta-analysis of Literature Studies. Seminars in thrombosis and hemostasis [PMC free article: PMC7645842] [PubMed: 32882719] | - Exclude - Not a study design specified in protocol |
| Di Renzo, Gian Carlo and Giardina, Irene (2020) Coronavirus disease 2019 in pregnancy: consider thromboembolic disorders and thromboprophylaxis. Am J Obstet Gynecol 223(1): 135–135 [PMC free article: PMC7175884] [PubMed: 32333857] | - Exclude - Not a study design specified in protocol |
| Falcoz, P.-E., Monnier, A., Puyraveau, M. et al. (2020) Extracorporeal membrane oxygenation for critically ill patients with COVID-19-related acute respiratory distress syndrome: Worth the effort?. American Journal of Respiratory and Critical Care Medicine 202(3): 460–463 [PMC free article: PMC7397791] [PubMed: 32543208] | - Exclude - Not a study design specified in protocol |
| Ferrandis, Raquel, Llau, Juan V, Quintana, Manuel et al. (2020) COVID-19: opening a new paradigm in thromboprophylaxis for critically ill patients?. Crit Care 24(1): 332–332 [PMC free article: PMC7289223] [PubMed: 32527286] | - Exclude - Not a study design specified in protocol |
| Frydman, Galit H, Boyer, Edward W, Nazarian, Rosalynn M et al. (2020) Coagulation Status and Venous Thromboembolism Risk in African Americans: A Potential Risk Factor in COVID-19. Clin Appl Thromb Hemost 26: 1076029620943671–1076029620943671 [PMC free article: PMC7383642] [PubMed: 32702995] | - Exclude - Not a study design specified in protocol |
| Hanif, Ahmad, Khan, Sumera, Mantri, Nikhitha et al. (2020) Thrombotic complications and anticoagulation in COVID-19 pneumonia: a New York City hospital experience. Annals of hematology 99(10): 2323–2328 [PMC free article: PMC7430929] [PubMed: 32808105] | - Exclude - Intervention does not match that specified in the protocol |
| Hasan, Syed Shahzad, Radford, Sam, Kow, Chia Siang et al. (2020) Venous thromboembolism in critically ill COVID-19 patients receiving prophylactic or therapeutic anticoagulation: a systematic review and meta-analysis. Journal of thrombosis and thrombolysis [PMC free article: PMC7396456] [PubMed: 32748122] | - Exclude - Not a study design specified in protocol |
| Hekimian, G., Lebreton, G., Brechot, N. et al. (2020) Severe pulmonary embolism in COVID-19 patients: A call for increased awareness. Critical Care 24: 274 [PMC free article: PMC7264962] [PubMed: 32487231] | - Exclude - Not a study design specified in protocol |
| Ho, K.S., Herrera, Y., Pattupara, A. et al. (2020) ANTICOAGULATION AND COVID-19: A META-ANALYSIS. Chest 158(4supplement): a2205 | - Exclude - surveillance study that would be excluded by development search filters |
| Huang, Yongshent, Lyu, Xiaoyu, Li, Dan et al. A cohort study of 223 patients explores the clinical risk factors for the severity diagnosis of COVID-19. medrxiv preprint | - Exclude - Not a study design specified in protocol |
| Huette, P., Beyls, C., Guilbart, M. et al. (2020) Extracorporeal membrane oxygenation for respiratory failure in COVID-19 patients: outcome and time-course of clinical and biological parameters. Canadian Journal of Anesthesia 67(10): 1486–1488 [PMC free article: PMC7263181] [PubMed: 32483742] | - Exclude - Not a study design specified in protocol |
| Klok, F A, Kruip, M J H A, van der Meer, N J M et al. (2020) Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thrombosis research 191: 145–147 [PMC free article: PMC7146714] [PubMed: 32291094] | - Exclude - Not a study design specified in protocol |
| Kumar, Poornima; Mediwake, Rapti; Rhead, Camilla (2020) A matter of time: duration and choice of venous thromboprophylaxis in patients diagnosed with COVID-19. Br J Hosp Med (Lond) 81(5): 1–2 [PubMed: 32468942] | - Exclude - Not a study design specified in protocol |
| Kwok, Benjamin, Brosnahan, Shari B, Amoroso, Nancy E et al. (2020) Pulmonary Embolism Response Team activation during the COVID-19 pandemic in a New York City Academic Hospital: a retrospective cohort analysis. Journal of thrombosis and thrombolysis [PMC free article: PMC7482370] [PubMed: 32910409] | - Exclude - Intervention does not match that specified in the protocol |
| Lachant, D.J., Lachant, N.A., Kouides, P. et al. (2020) Chronic therapeutic anticoagulation is associated with decreased thrombotic complications in SARS-CoV-2 infection. Journal of Thrombosis and Haemostasis 18(10): 2640–2645 [PMC free article: PMC9770966] [PubMed: 33448631] | - Exclude - Not a study design specified in protocol |
| Liao, S.-C., Shao, S.-C., Chen, Y.-T. et al. (2020) Incidence and mortality of pulmonary embolism in COVID-19: A systematic review and meta-analysis. Critical Care 24(1): 464 [PMC free article: PMC7384281] [PubMed: 32718343] | - Exclude - Not a study design specified in protocol |
| Llitjos, Jean-Francois, Leclerc, Maxime, Chochois, Camille et al. (2020) High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients. Journal of thrombosis and haemostasis : JTH 18(7): 1743–1746 [PMC free article: PMC7264774] [PubMed: 32320517] | - Exclude - duplicate content |
| Lucarelli, E., Behn, C., Lashley, S. et al. (2020) Mechanical Ventilation in Pregnancy Due to COVID-19: A Cohort of Three Cases. American Journal of Perinatology 37(1): 1066–1069 [PMC free article: PMC7426329] [PubMed: 32544963] | - Exclude - Not a study design specified in protocol |
| Maldonado, Edward; Tao, Derrick; Mackey, Katherine (2020) Antithrombotic Therapies in COVID-19 Disease: a Systematic Review. Journal of general internal medicine 35(9): 2698–2706 [PMC free article: PMC7299557] [PubMed: 32556875] | - Exclude - duplicate content |
| Manolis, A.S., Manolis, T.A., Manolis, A.A. et al. (2020) COVID-19 Infection: Viral Macro- and Micro-Vascular Coagulopathy and Thromboembolism/Prophylactic and Therapeutic Management. Journal of Cardiovascular Pharmacology and Therapeutics [PMC free article: PMC7492826] [PubMed: 32924567] | - Exclude - Not a study design specified in protocol |
| Mattioli, M., Benfaremo, D., Mancini, M. et al. (2020) Safety of intermediate dose of low molecular weight heparin in COVID-19 patients. Journal of Thrombosis and Thrombolysis [PMC free article: PMC7426007] [PubMed: 32794132] | - Exclude - Not a study design specified in protocol |
| Maurer, L.R., Luckhurst, C.M., Hamidi, A. et al. (2020) A low dose heparinized saline protocol is associated with improved duration of arterial line patency in critically ill COVID-19 patients. Journal of Critical Care 60: 253–259 [PMC free article: PMC7467123] [PubMed: 32920504] | - Exclude - Intervention does not match that specified in the protocol |
| McBane, Robert D., Torres Roldan, Victor D., Niven, Alexander S. et al. (2020) Anticoagulation in COVID-19: A Systematic Review, Meta-Analysis and Rapid Guidance From The Mayo Clinic. Mayo Clinic Proceedings [PMC free article: PMC7458092] [PubMed: 33153635] | - Exclude - duplicate content |
| Mortus, J.R., Manek, S.E., Brubaker, L.S. et al. (2020) Thromboelastographic Results and Hypercoagulability Syndrome in Patients with Coronavirus Disease 2019 Who Are Critically Ill. JAMA Network Open 3(6): e2011192 [PMC free article: PMC7275245] [PubMed: 32501489] | - Exclude - Outcome does not match that specified in the protocol |
| Nahum, J., Morichau-Beauchant, T., Daviaud, F. et al. (2020) Venous Thrombosis among Critically Ill Patients with Coronavirus Disease 2019 (COVID-19). JAMA Network Open 3(5): 10478 [PMC free article: PMC7260620] [PubMed: 32469410] | - Exclude - Not a study design specified in protocol |
| NCT04401293 (2020) Full Dose Heparin Vs. Prophylactic Or Intermediate Dose Heparin in High Risk COVID-19 Patients. https://clinicaltrials.gov/show/NCT04401293 | - Exclude - Not a study design specified in protocol |
| NCT04408235 (2020) High Versus Low LMWH Dosages in Hospitalized Patients With Severe COVID-19 Pneumonia and Coagulopathy. https://clinicaltrials.gov/show/NCT04408235 [PMC free article: PMC7316577] [PubMed: 32586394] | - Exclude - Not a study design specified in protocol |
| NCT04409834 (2020) Prevention of Arteriovenous Thrombotic Events in Critically-Ill COVID-19 Patients Trial. https://clinicaltrials.gov/show/NCT04409834 | - Exclude - Not a study design specified in protocol |
| NCT04508439 (2020) Effect of the Use of Anticoagulant Therapy During Hospitalization and Discharge in Patients With COVID-19 Infection. https://clinicaltrials.gov/show/NCT04508439 | - Exclude - Not a study design specified in protocol |
| Nopp, Stephan, Moik, Florian, Jilma, Bernd et al. (2020) Risk of venous thromboembolism in patients with COVID-19: A systematic review and meta-analysis. Research and practice in thrombosis and haemostasis [PMC free article: PMC7537137] [PubMed: 33043231] | - Exclude - Intervention does not match that specified in the protocol |
| Pawlowski, Colin, Venkatakrishnan, AJ, Kirkup, Christian et al. Enoxaparin is associated with lower rates of thrombosis, kidney injury, and mortality than Unfractionated Heparin in hospitalized COVID patients. medrxiv preprint [PMC free article: PMC7941023] [PubMed: 33718845] | - Exclude - Intervention does not match that specified in the protocol |
| Piagnerelli, Michaël; Cauchie, Philippe; Wautrecht, Jean-Claude (2020) Optimizing the Risk-Benefit Balance of Thromboprophylaxis in Critically Ill Patients With Coronavirus Disease 2019. Crit Care Med 48(10): e988–e989 [PMC free article: PMC7375185] [PubMed: 32706558] | - Exclude - Not a study design specified in protocol |
| Piazza, Ornella (2020) Should lCU COVID-19 patients empirically receive therapeutic doses of anticoagulant?. Infez Med 28(suppl1): 4–5 [PubMed: 32532932] | - Exclude - Not a study design specified in protocol |
| Pooni, Rajan S (2020) Research in brief: Coagulopathy in COVID-19: Determining and managing thrombotic risk in COVID-19 infection. Clinical medicine (London, England) 20(4): e59 [PMC free article: PMC7385779] [PubMed: 32675158] | - Exclude - Not a study design specified in protocol |
| Porfidia, Angelo and Pola, Roberto (2020) Venous Thromboembolism and Heparin Use in COVID-19 Patients: Juggling between Pragmatic Choices, Suggestions of Medical Societies and the Lack of Guidelines. J Thromb Thrombolysis 50(1): 68–71 [PMC free article: PMC7196627] [PubMed: 32367471] | - Exclude - Not a study design specified in protocol |
| Prandoni, P., Cattelan, A.M., Carrozzi, L. et al. (2020) The hazard of fondaparinux in non-critically ill patients with COVID-19: Retrospective controlled study versus enoxaparin. Thrombosis Research 196: 395–397 [PMC free article: PMC7497738] [PubMed: 33007739] | - Exclude - Not a study design specified in protocol |
| Roberts, Lara N, Whyte, Martin B, Georgiou, Loizos et al. (2020) Postdischarge venous thromboembolism following hospital admission with COVID-19. Blood 136(11): 1347–1350 [PMC free article: PMC7483432] [PubMed: 32746455] | - Exclude - Not a study design specified in protocol |
| Russo, Vincenzo, Cardillo, Giuseppe, Viggiano, Giuseppe Vito et al. (2020) Fondaparinux Use in Patients With COVID-19: A Preliminary Multicenter Real-World Experience. Journal of cardiovascular pharmacology 76(4): 369–371 [PubMed: 33027192] | - Exclude - Outcome does not match that specified in the protocol |
| Savioli, Felicio (2020) Is there a rationale for heparin use among severe COVID-19 patients?. Einstein (Sao Paulo) 18: eed5758–eed5758 [PMC free article: PMC7239568] [PubMed: 32490886] | - Exclude - Not a study design specified in protocol |
| Schiavone, M., Gasperetti, A., Mancone, M. et al. (2020) Oral anticoagulation and clinical outcomes in COVID-19: An Italian multicenter experience. International Journal of Cardiology [PMC free article: PMC7476907] [PubMed: 32911000] | - Exclude - Intervention does not match that specified in the protocol |
| Shah, Akshay, Donovan, Killian, McHugh, Anna et al. (2020) Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: a multicentre observational study. Critical care (London, England) 24(1): 561 [PMC free article: PMC7499016] [PubMed: 32948243] | - Exclude - Not a study design specified in protocol |
| Spyropoulos, Alex C; Ageno, Walter; Barnathan, Elliot S (2020) Hospital-based use of thromboprophylaxis in patients with COVID-19. Lancet 395(10234): e75–e75 [PMC free article: PMC7173816] [PubMed: 32330428] | - Exclude - Not a study design specified in protocol |
| Stattin, K., Lipcsey, M., Andersson, H. et al. (2020) Inadequate prophylactic effect of low-molecular weight heparin in critically ill COVID19 patients. Journal of Critical Care 60: 249–252 [PMC free article: PMC7470731] [PubMed: 32920503] | - Exclude - Not a study design specified in protocol |
| Stessel, Bjorn, Vanvuchelen, Charlotte, Bruckers, Liesbeth et al. (2020) Impact of implementation of an individualised thromboprophylaxis protocol in critically ill ICU patients with COVID-19: A longitudinal controlled before-after study. Thrombosis research 194: 209–215 [PMC free article: PMC7375318] [PubMed: 32788120] | - Exclude - duplicate content |
| Susen, Sophie, Tacquard, Charles Ambroise, Godon, Alexandre et al. (2020) Prevention of thrombotic risk in hospitalized patients with COVID-19 and hemostasis monitoring. Crit Care 24(1): 364–364 [PMC free article: PMC7303590] [PubMed: 32560658] | - Exclude - Not a study design specified in protocol |
| Tang, Ning, Bai, Huan, Chen, Xing et al. (2020) Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. Journal of thrombosis and haemostasis : JTH 18(5): 1094–1099 [PMC free article: PMC9906401] [PubMed: 32220112] | - Exclude - duplicate content |
| Trigonis, Russell A, Holt, Daniel B, Yuan, Rebecca et al. (2020) Incidence of Venous Thromboembolism in Critically Ill Coronavirus Disease 2019 Patients Receiving Prophylactic Anticoagulation. Critical care medicine 48(9): e805–e808 [PMC free article: PMC7314344] [PubMed: 32618699] | - Exclude - Not a study design specified in protocol |
| Trimaille, Antonin, Curtiaud, Anais, Marchandot, Benjamin et al. (2020) Venous thromboembolism in non-critically ill patients with COVID-19 infection. Thrombosis research 193: 166–169 [PMC free article: PMC7367026] [PubMed: 32707275] | - Exclude - Not a study design specified in protocol |
| Tritschler, T., Mathieu, M.-E., Skeith, L. et al. (2020) Anticoagulant interventions in hospitalized patients with COVID-19: A scoping review of randomized controlled trials and call for international collaboration. Journal of Thrombosis and Haemostasis [PMC free article: PMC9906402] [PubMed: 32888372] | - Exclude - Not a study design specified in protocol |
| Turan, O., Hakim, A., Dashraath, P. et al. (2020) Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS-CoV-2 infection among hospitalized pregnant women: A systematic review. International Journal of Gynecology and Obstetrics 151(1): 7–16 [PMC free article: PMC9087651] [PubMed: 32816307] | - Exclude - Outcome does not match that specified in the protocol |
| Viecca, Maurizio, Radovanovic, Dejan, Forleo, Giovanni Battista et al. (2020) Enhanced platelet inhibition treatment improves hypoxemia in patients with severe Covid-19 and hypercoagulability. A case control, proof of concept study. Pharmacological research 158: 104950 [PMC free article: PMC7244436] [PubMed: 32450344] | - Exclude - Not a study design specified in protocol |
| Zermatten, M.G., Pantet, O., Gomez, F. et al. (2020) Utility of D-dimers and intermediate-dose prophylaxis for venous thromboembolism in critically ill patients with COVID-19. Thrombosis Research 196: 222–226 [PMC free article: PMC7442003] [PubMed: 32916564] | - Exclude - Not a study design specified in protocol |
| Zhang, Chi, Shen, Long, Le, Ke-Jia et al. (2020) Incidence of Venous Thromboembolism in Hospitalized Coronavirus Disease 2019 Patients: A Systematic Review and Meta-Analysis. Frontiers in cardiovascular medicine 7: 151 [PMC free article: PMC7423832] [PubMed: 32850990] | - Exclude - Not a study design specified in protocol |
| Zhang, Li, Feng, Xiaokai, Zhang, Danqing et al. (2020) Deep Vein Thrombosis in Hospitalized Patients With COVID-19 in Wuhan, China: Prevalence, Risk Factors, and Outcome. Circulation 142(2): 114–128 [PubMed: 32421381] | - Exclude - Not a study design specified in protocol |
| Flumignan, R.L.G., Tinoco, J.D.D.S.a., Pascoal, P.I.F. et al. (2020) Prophylactic anticoagulants for people hospitalised with COVID-19. Cochrane Database of Systematic Reviews 2020(9): cd013739 [PMC free article: PMC8166900] [PubMed: 33502773] | - Exclude – relevant for review question 1 |
| Lu, Ying-Feng, Pan, Li-Ya, Zhang, Wen-Wu et al. (2020) A meta-analysis of the incidence of venous thromboembolic events and impact of anticoagulation on mortality in patients with COVID-19. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 100: 34–41 [PMC free article: PMC7425668] [PubMed: 32798659] | - Exclude – relevant for review question 1 |
| Mohamed Mouhand, F.H., Shokri Shaikha D., Al-Shokri, Shunnar Khaled, M. et al. Prevalence of Venous Thromboembolism in Critically-ill COVID-19 Patients: Systematic Review and Meta-analysis. medrxiv preprint | - Exclude – relevant for review question 1 |
| Lemos, A.C.B., do Espirito Santo, D.A., Salvetti, M.C. et al. (2020) Therapeutic versus prophylactic anticoagulation for severe COVID-19: A randomized phase II clinical trial (HESACOVID). Thrombosis Research 196: 359–366 [PMC free article: PMC7503069] [PubMed: 32977137] | - Exclude – relevant for review question 1 |
| Atallah, B, Sadik, Z G, Salem, N et al. (2020) The impact of protocol-based high-intensity pharmacological thromboprophylaxis on thrombotic events in critically ill COVID-19 patients. Anaesthesia [PMC free article: PMC7675553] [PubMed: 33047335] | - Exclude – relevant for review question 1 |
| Ferguson, John, Volk, Stacy, Vondracek, Thomas et al. (2020) Empiric Therapeutic Anticoagulation and Mortality in Critically Ill Patients With Respiratory Failure From SARS-CoV-2: A Retrospective Cohort Study. Journal of clinical pharmacology 60(11): 1411–1415 [PubMed: 32885463] | - Exclude – relevant for review question 1 |
| Jimenez-Guiu, Xavier, Huici-Sanchez, Malka, Romera-Villegas, Antonio et al. (2020) Deep vein thrombosis in non-critically ill patients with coronavirus disease 2019 pneumonia: deep vein thrombosis in non-intensive care unit patients. Journal of vascular surgery. Venous and lymphatic disorders [PMC free article: PMC7476444] [PubMed: 32911110] | - Exclude – relevant for review question 1 |
| Jonmarker, Sandra, Hollenberg, Jacob, Dahlberg, Martin et al. DOSING OF THROMBOPROPHYLAXIS AND MORTALITY IN CRITICALLY ILL COVID-19 PATIENTS. medrxiv preprint [PMC free article: PMC7680989] [PubMed: 33225952] | - Exclude – relevant for review question 1 |
| Li, Matthew, Gitarts, Steven, Nyabera, Akwe et al. (2020) Continuous Infusion Low-Dose Unfractionated Heparin for the Management of Hypercoagulability Associated With COVID-19. Journal of Pharmacy Practice | - Exclude – relevant for review question 1 |
| Longhitano, Yaroslava, Racca, Fabrizio, Zanza, Christian et al. (2020) Venous Thrombo-Embolism in Hospitalized SARS-CoV-2 Patients Treated with Three Different Anticoagulation Protocols: Prospective Observational Study. Biology 9(10) [PMC free article: PMC7600769] [PubMed: 32987902] | - Exclude – relevant for review question 1 |
| Motta Jishu, K, Ogunnaike Rahila, O, Shah, Rutvik et al. Clinical Outcomes With the Use of Prophylactic Versus Therapeutic Anticoagulation in COVID-19. medrxiv preprint | - Exclude – relevant for review question 1 |
| Nadkarni, G.N., Lala, A., Bagiella, E. et al. (2020) Anticoagulation, Bleeding, Mortality, and Pathology in Hospitalized Patients With COVID-19. Journal of the American College of Cardiology 76(16): 1815–1826 [PMC free article: PMC7449655] [PubMed: 32860872] | - Exclude – relevant for review question 1 |
| Paolisso, Pasquale, Bergamaschi, Luca, D’Angelo, Emanuela Concetta et al. (2020) Preliminary Experience With Low Molecular Weight Heparin Strategy in COVID-19 Patients. Frontiers in pharmacology 11: 1124 [PMC free article: PMC7424043] [PubMed: 32848743] | - Exclude – relevant for review question 1 |
| Pavoni, V., Gianesello, L., Pazzi, M. et al. (2020) Venous thromboembolism and bleeding in critically ill COVID-19 patients treated with higher than standard low molecular weight heparin doses and aspirin: A call to action. Thrombosis Research 196: 313–317 [PMC free article: PMC7487146] [PubMed: 32977129] | - Exclude – relevant for review question 1 |
| Taccone, Fabio Silvio, Gevenois, Pierre Alain, Peluso, Lorenzo et al. (2020) Higher Intensity Thromboprophylaxis Regimens and Pulmonary Embolism in Critically Ill Coronavirus Disease 2019 Patients. Critical care medicine 48(11): e1087–e1090 [PMC free article: PMC7437413] [PubMed: 32769623] | - Exclude – relevant for review question 1 |
- Evidence review question 2 - COVID-19 rapid evidence review: reducing the risk o...Evidence review question 2 - COVID-19 rapid evidence review: reducing the risk of venous thromboembolism in over 16s
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