OC 13.2 - Convalescent Plasma Therapy Does Not Increase the Risk of Thromboembolism in The Treatment of COVID-19: A Systematic Review and Meta-Analysis

Background: Convalescent plasma therapy (CPT) has been issued emergency use authorization for the treatment of SARS-CoV-2 (COVID-19) by the United States Food and Drug Administration. The presence of coagulation factors in CPT in combination with the pro-thrombotic state COVID-19 patients are in may potentiate their risk of thrombotic events.

Aims: To assess the risk of venous thromboembolisms (VTE) and arterial thromboembolisms (ATE) in COVID-19 patients undergoing CPT.

Methods: MEDLINE, Embase, and Cochrane CENTRAL were searched for randomized controlled trials that investigated the safety and efficacy of CPT and standard of care (SOC) against placebo or SOC alone in adult COVID-19 patients. Study selection and data extraction were done in duplicate. The primary outcome was the development of VTE and ATE. The secondary outcomes were 30-day mortality, clinical improvement, length of hospitalization (LOH), sepsis/fever, and major adverse cardiovascular events (MACE). Meta-analysis was conducted using the Mantel-Haenszel random effects model. Binary endpoints and continuous endpoints were synthesized using odd ratios (OR) and mean differences respectively with 95% confidence intervals (CI).

Results: 17 randomized controlled trials including 18566 patients were included (Table 1). The risk of VTE and ATE did not differ between the CPT and the control group. There were also no significant differences in 30-day mortality, clinical improvement, LOH, risk of sepsis/fever, and MACE. A summary of outcomes is illustrated in Table 2.

Conclusion(s): Treatment of COVID-19 with CPT does not appear to be associated with an increased risk of VTE, ATE, or adverse events but also does not appear to provide mortality or clinical benefit.