Venous thromboembolism in COVID-19: A systematic review and meta-analysis.

Anastasios Kollias,George S Stergiou,Evangelos Kontopantelis,Konstantinos Syrigos,Konstantinos G Kyriakoulis,Styliani Lagou

doi:10.1177/1358863x21995566

Abstract

Severe coronavirus disease 2019 (COVID-19) is associated with increased risk of venous thromboembolism events (VTE). This study performed a systematic review in PubMed/EMBASE of studies reporting the prevalence of VTE in patients with COVID-19 who were totally screened/assessed for deep vein thrombosis (DVT) and/or for pulmonary embolism (PE). Among 47 candidate studies (n = 6459; 33 in Europe), 17 studies (n = 3973; weighted age 63.0 years, males 60%, intensive care unit (ICU) 16%) reported the prevalence of PE with a pooled estimate of 32% (95% CI: 25, 40%), and 32 studies (n = 2552; weighted age 62.6 years, males 57%, ICU 49%) reported the prevalence of DVT with a pooled estimate of 27% (95% CI: 21, 34%). A total of 36 studies reported the use of at least prophylactic antithrombotic treatment in the majority of their patients. Meta-regression analysis showed that the prevalence of VTE was higher across studies with a higher percentage of ICU patients and higher study population mean D-dimer values, and lower in studies with mixed dosing of anticoagulation in ⩾ 50% of the population compared to studies with standard prophylactic dosing of anticoagulation in < 50% of the population. The pooled odds ratio for death in patients with COVID-19 and VTE versus those without VTE (17 studies, n = 2882) was 2.1 (95% CI: 1.2, 3.6). Hospitalized patients with severe COVID-19 are at high VTE risk despite prophylactic anticoagulation. Further research should investigate the individualized VTE risk of patients with COVID-19 and the optimal preventive antithrombotic therapy. PROSPERO Registration No.: CRD42020185543.

Highlights

Coronavirus disease 2019 (COVID-19) has been identified mainly as a viral respiratory tract infection, it has become evident that several complications render a systematic approach to this new infectious disease necessary
Emerging evidence shows that severe COVID-19 is often complicated with coagulopathy, which has prothrombotic effects resulting in high risk of venous thromboembolism events (VTE) and mortality.[1,2,3]
In plots of prevalence versus study sample size, there was a trend for higher pulmonary embolism (PE) prevalence in smaller studies, but there was no apparent trend in deep vein thrombosis (DVT) prevalence

Summary

Introduction

Coronavirus disease 2019 (COVID-19) has been identified mainly as a viral respiratory tract infection, it has become evident that several complications render a systematic approach to this new infectious disease necessary. Preliminary evidence suggests that anticoagulant therapy might provide a survival benefit in patients with severe COVID-19.4,5 This issue is being increasingly recognized by international societies that strongly recommend the use of thromboprophylaxis in all hospitalized patients.[6,7,8,9,10]. This study aimed to review the current evidence regarding the prevalence of VTE in patients with COVID-19 screened/assessed with lower limb ultrasonography or computed tomography pulmonary angiography Emerging evidence shows that severe COVID-19 is often complicated with coagulopathy, which has prothrombotic effects resulting in high risk of venous thromboembolism events (VTE) and mortality.[1,2,3] it appears that there is a significant heterogeneity in the observed VTE phenotypes (isolated deep vein thrombosis (DVT), isolated pulmonary embolism (PE)/thrombosis, combined DVT and PE)[2] and the prevalence of VTE among screened patients remains understudied.

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