In this prospectively designed meta-analysis of randomized trials, administration of therapeutic- compared with prophylactic-dose anticoagulation with heparins to patients hospitalized for COVID-19 was associated with 23% lower 28-day mortality.

Trials making this comparison were mainly conducted in patients requiring no or low oxygen at random assignment.

By contrast, mortality was higher for therapeutic- compared with intermediate-dose anticoagulation, although this comparison was not estimated precisely.

The risk for 28-day mortality was similar for intermediate- versus prophylactic-dose anticoagulation.

Associations with progression to IMV or death were similar to those for 28-day mortality.

For each comparison of higher and lower doses of anticoagulation, the risk for major bleeding was greater, but the risk for thromboembolic events was lower.

Associations between dose of anticoagulation and outcome appeared broadly consistent across all predefined patient subgroups, although some analyses had limited power to detect interactions.

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