Efficacy and safety of anticoagulation in cardiac arrest: a systematic review and meta-analysis

Abstract

Background: Evidence on the effectiveness of anticoagulation therapy in patients with cardiac arrest is scarce. We aimed to compare the effectiveness of anticoagulation therapy in patients with cardiac arrest by systematic evaluation and meta-analysis.

Methods: The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were followed. We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from database inception until December 31, 2022, comparing adjuvant anticoagulation to standard care during cardiac arrest. Odds ratios with 95% confidence intervals were calculated using a random-effects model. The population included adults with cardiac arrest in any setting. Pairs of investigators reviewed studies for relevance, extracted data, and assessed the risk of bias. This study was registered with PROSPERO (International Prospective Register of Systematic Reviews).

Results: Four studies were included in the final meta-analysis (1 randomized controlled trial, 1 nonrandomized controlled trial, and 2 observational studies). A total of 1374 patients (412 in the intervention group and 962 in the control group) were included. The results show that anticoagulant interventions increased return of spontaneous circulation compliance compared with control, improved neurological prognosis, and are potentially associated with in-hospital survival. The risk of bleeding in the intervention and control groups and 24-hour survival between these groups were not significantly different.

Conclusion: Anticoagulation during cardiac arrest was associated with achieving return of spontaneous circulation, improving survival to hospitalization, and potentially ameliorating neurologic prognosis in patients. Moreover, anticoagulation did not increase the incidence of bleeding events.

Keywords

Anticoagulants / Cardiac arrest / Heparin / Meta-analysis

Conflict of interest statement

Yuguo Chen, Editor-in-Chief of Emergency and Critical Care Medicine, confirms no involvement in any stage of this article’s peer-review process, ensuring unbiased editorial decision-making. The authors declare no conflict of interest.

Author contributions

Zong M and Tian R conceived and designed the study and indepen-dently completed database search and screening and data extrac-tion. Zhang J assessed the eligibility of unresolved studies between the 2 authors. Zong M and Zhang J inspected and verified the data. Zong M performed all statistical analysis on R 4.3.1. Zong M and Tian R wrote the manuscript, and Zhang J revised the finished man-uscript. Li C and Chen Y provided suggestions on summarizations and statistical analysis. All authors read and approved the final ver-sion of the manuscript.

Funding

This work was supported by the National Natural Science Foun-dation of China (82070388 and 82170442), Taishan Scholar Program of Shandong Province (tspd20181220 and tsqn202211310), National Natural Science Foundation of Shandong Province (ZR2020MH035), National Key R&D Program of China (2020YFC1512700, 2020YFC1512705, 2020YFC1512703, 2022YFC0868600), Key R&D Program of Shandong Province (2021ZLGX02, 2021SFGC0503, 2022ZLGX03), National Sci-ence & Technology Fundamental Resources Investigation Project (2018FY100600, 2018FY100602), The Interdisciplinary Young Researcher Groups Program of Shandong University (2020QNQT004), Youth Top-Talent Project of National Ten Thousand Talents Plan, and Qilu Young Scholar Program.

Ethical approval of studies and informed consent

All studies included in this study followed the principles of the Dec-laration of Helsinki as revised in 2013.

Acknowledgments

None.

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