Abstract
Introduction: Preliminary evidence indicates that prophylactic-dosing thromboprophylaxis may be inadequate to control the increased risk of venous thromboembolism (VTE) in coronavirus disease 2019 (COVID-19) patients, and the usefulness of D-dimer measurement as a biomarker for VTE risk classification in this setting remains unclear. The study aimed to estimate the incidence of VTE and examine the difference in D-dimer levels among anticoagulated COVID-19 patients with and without VTE incident. Methods: This study was conducted in accordance with the PRISMA guidelines, and the protocol was registered in PROSPERO (Registration Number: CRD42020189192). A comprehensive literature search of PubMed from inception to May 2020 was performed to harvest original studies that reported the frequency of VTE and death among COVID-19 patients who received thromboprophylaxis on hospitalization. The endpoints included VTE (a composite of pulmonary embolism [PE] or deep vein thrombosis [DVT]), PE, DVT, and mortality. Results: A total of 11 cohort studies were included. Among hospitalized COVID-19 patients, 23.9% (95% confidence interval [CI], 16.2% to 33.7%) developed VTE despite anticoagulation. PE and DVT were detected in 11.6% (95% CI, 7.5% to 17.5%) and 11.9% (95% CI, 6.3% to 21.3%) of patients, respectively. Patients in the intensive care unit had a higher risk for VTE (30.4% [95% CI, 19.6% to 43.9%]) than those in the ward (13.0% [95% CI, 5.9% to 26.3%]). The mortality was estimated at 21.3% (95% CI, 17.0% to 26.4%). COVID-19 patients who developed VTE had higher D-dimer levels than those who did not develop VTE (mean difference, 2.05 μg/mL; 95% CI, 0.30 to 3.80 μg/mL; P=0.02). Conclusions: Heightened risk of VTE in COVID-19 despite prophylactic anticoagulation calls into research on optimal thromboprophylaxis and risk stratification. Prominent elevation of D-dimer may be associated with VTE development and can be used to identify high-risk subsets.
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