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

Abstract

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.