Abstract
Background: Preliminary evidence indicates that prophylactic-dose thromboprophylaxis may be inadequate to control the increased risk of venous thromboembolism (VTE) in patients hospitalized for coronavirus disease 2019 (COVID-19) infection. Additionally, it remains unclear whether the D-dimer measurement is useful for VTE risk stratification among COVID-19 patients. This study aimed to offer benchmark data on the incidence of VTE and to examine the difference in D-dimer levels among anticoagulated COVID-19 patients with and without VTE incident. Methods: A comprehensive literature review of PubMed from inception to May 2020 was performed for 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%; I2 = 93%) developed VTE despite anticoagulation. PE and DVT were detected in 11.6% (95% CI, 7.5% to 17.5%; I2 = 92%) and 11.9% (95% CI, 6.3% to 21.3%; I2 = 93%) of patients, respectively. Patients in the intensive care unit (ICU) 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%; I2 = 53%). 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: The heightened and heterogeneous risk of VTE in COVID-19 despite prophylactic anticoagulation calls into research on the pathogenesis of thromboembolic complications and strategy of thromboprophylaxis and risk stratification. Prominent elevation of D-dimer may be associated with VTE development and can be used to identify high-risk subsets.
Highlights
Patients with coronavirus disease 2019 (COVID-19) infection may present with a diverse clinical spectrum, ranging from asymptomatic carriage, mild respiratory or gastrointestinal symptoms, to severe pneumonia and multi-organ failure [1,2]
COVID-19 infection may be associated with abnormalities in coagulation parameters (e.g., D-dimer, prothrombin time, partial thromboplastin time, fibrin/fibrinogen degradation products, and platelet counts) that are consistent with infection-induced inflammatory changes as observed in disseminated intravascular coagulopathy [3]
Human studies, published as original research articles, letters, or brief reports that reported the incidence of study endpoints (VTE, pulmonary embolism (PE), deep vein thrombosis (DVT), or mortality) among hospitalized patients with laboratory-confirmed COVID-19 infection who received at least standard doses of thromboprophylaxis with unfractionated heparin (UFH) or low molecular weight heparin (LMWH) were included
Summary
Patients with coronavirus disease 2019 (COVID-19) infection may present with a diverse clinical spectrum, ranging from asymptomatic carriage, mild respiratory or gastrointestinal symptoms, to severe pneumonia and multi-organ failure [1,2]. COVID-19 infection may be associated with abnormalities in coagulation parameters (e.g., D-dimer, prothrombin time, partial thromboplastin time, fibrin/fibrinogen degradation products, and platelet counts) that are consistent with infection-induced inflammatory changes as observed in disseminated intravascular coagulopathy [3]. D-dimer, fibrinogen, prothrombin time, and platelet count to determine prognosis and assist management decision in COVID-19 patients requiring hospitalization [8]. Preliminary evidence indicates that prophylactic-dose thromboprophylaxis may be inadequate to control the increased risk of venous thromboembolism (VTE) in patients hospitalized for coronavirus disease 2019 (COVID-19) infection. It remains unclear whether the D-dimer measurement is useful for VTE risk stratification among COVID-19 patients.
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