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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

Authors

  • Azita H. Talasaz 

    1   Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
    2   Department of Pharmacotherapy and Outcome Sciences, Virginia Commonwealth University, Richmond, Virginia, United States

  • Parham Sadeghipour 

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

  • Kasra Mehdizadeh

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

  • Niloofar Khoshnam Rad

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

  • Behnood Bikdeli

    5   Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
    6   Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
    7   Yale/YNHH Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States
    8   Cardiovascular Research Foundation (CRF), New York, New York, United States

  • Gregory Y. H. Lip 

    9   Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
    10   Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

  • Job Harenberg

    11   Ruprecht Karls University, Heidelberg, Germany
    12   Ruperto Carola University of Heidelberg, Heidelberg, Germany

Funding Dr. B.B. is supported by the Scott Schoen and Nancy Adams IGNITE Award from the Mary Horrigan Connors Center for Women's Health and Gender Biology at Brigham and Women's Hospital and a Career Development Award from the American Heart Association and VIVA Physicians (#938814).
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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

Disclosures

Dr. B.B. reports that he is a consulting expert, on behalf of the plaintiff, for litigation related to two specific brand models of IVC filters.


Dr G.Y.H.L.: consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, and Daiichi-Sankyo. No fees are received personally.


Dr J.H.: founder and managing director of DOASENSE GmbH.


All other authors report no relevant disclosures.


Note: The review process for this paper was fully handled by Christian Weber, Editor-in-Chief.


Supplementary Material



Publication History

Received: 07 June 2022

Accepted: 20 August 2022

Accepted Manuscript online:
07 October 2022

Article published online:
30 December 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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