Knowledge Gaps for Prophylactic Use of Antithrombotic Agents in Patients with COVID-19: Insights into New SARS-CoV-2 Variants, Vaccination Status, and Emerging Oral Antivirals

Azita H. Talasaz; Parham Sadeghipour; Kasra Mehdizadeh; Niloofar Khoshnam Rad; Behnood Bikdeli; Gregory Y. H. Lip; Job Harenberg

doi:10.1055/a-1956-9641

Thrombosis and Haemostasis, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Thromb Haemost 2023; 123(02): 186-191
DOI: 10.1055/a-1956-9641

Review Article

Knowledge Gaps for Prophylactic Use of Antithrombotic Agents in Patients with COVID-19: Insights into New SARS-CoV-2 Variants, Vaccination Status, and Emerging Oral Antivirals

Azita H. Talasaz

¹Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

²Department of Pharmacotherapy and Outcome Sciences, Virginia Commonwealth University, Richmond, Virginia, United States

,

Parham Sadeghipour

³Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

⁴Clinical Trial Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran

,

Kasra Mehdizadeh

³Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

,

Niloofar Khoshnam Rad

¹Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

,

Behnood Bikdeli

⁵Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

⁶Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

⁷Yale/YNHH Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States

⁸Cardiovascular Research Foundation (CRF), New York, New York, United States

,

Gregory Y. H. Lip

⁹Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom

¹⁰Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

,

Job Harenberg

¹¹Ruprecht Karls University, Heidelberg, Germany

¹²Ruperto Carola University of Heidelberg, Heidelberg, Germany

› Institutsangaben

Abstract

Data suggest that coronavirus disease 2019 (COVID-19) results in a prothrombotic state leading to arterial and venous thromboses. Vaccination, novel antiviral drugs, and emerging variants have changed the course of the disease in many ways; however, their effects on the incidence of thrombotic events and the efficacy of preventative antithrombotic agents have not been yet evaluated. A systematic search was conducted to identify studies reported on the incidence of thrombotic events based on vaccination status, use of novel antiviral drugs, and emerging viral variants. Similarly, we screened the ongoing/published randomized trials of preventative antithrombotic therapy in any COVID-19 population to assess whether subgroup-specific results were reported based on any of these variants. Upon searching a total of 3,451 records, only one entry fulfilled the inclusion criteria of our systematic review, which was a self-controlled case series on 29,121,633 vaccinated individuals, the incidence rate ratio of thrombotic complication after breakthrough infection was 13.86 (95% confidence interval [CI]: 12.76–15.05) compared with 1.10 (95% CI: 1.02–1.18) during the 28-day postvaccination. In conclusion, although the mortality benefit of mass vaccination and the early promising results of the new antiviral therapies are well known, we were unable to find clinical evidence on whether vaccination, the use of novel antiviral agents, and emerging viral variants have affected the incidence rate of thrombotic events or impacted the efficacy of prophylactic antithrombotic therapy in patients with COVID-19. Analyses from existing trials and large-scale registries can provide interim knowledge and any findings of relevance should be incorporated in the design of future trials.

Keywords

thromboembolism - anticoagulation - SARS-CoV-2 - vaccination - COVID-19

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Referenzen

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