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Am Fam Physician. 2022;106(5):501-502

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Clinical Question

Do anticoagulants reduce the risk of venous thromboembolism or mortality in people hospitalized with COVID-19?

Evidence-Based Answer

In people hospitalized with COVID-19, the use of anticoagulants reduces all-cause mortality (number needed to treat [NNT] = 9; 95% CI, 7.3 to 13). Using a higher dose of anticoagulants may reduce the risk of pulmonary embolism (PE) compared with a lower dose of the same agent (NNT = 56; 95% CI, 44 to 100). Using a higher dose also increases the risk of major bleeding (number needed to harm [NNH] = 100; 95% CI, 42 to 1,000) and minor bleeding (NNH = 50; 95% CI, 10 to 67).1 (Strength of Recommendation: B, inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

All patients with COVID-19 are at risk of thromboembolic complications, including deep venous thrombosis (DVT) and PE, and bleeding complications.2 In patients hospitalized with COVID-19, rates of DVT (up to 14.8%) and PE (up to 16.5%) are much higher than rates of DVT and PE in hospitalized patients in the United States (0.15% for DVT and 0.1% for PE).3,4 Clotting and bleeding complications associated with COVID-19 may be caused by dysregulation of the coagulation cascade in response to viral infection.5 The authors of this Cochrane review sought to clarify the benefits and risks of anticoagulation for persons hospitalized with COVID-19.

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These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.

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