Incidence of venous and arterial thromboembolic complications in COVID-19: A systematic review and meta-analysis

Abstract

Incidence of venous and arterial thromboembolic complications in COVID-19: A systematic review and meta-analysisTo the Editors Arterial thrombotic disease (atherosclerotic cardiovascular disease, CVD) and venous thromboembolism (VTE) (comprising of deep vein thrombosis (DVT) and pulmonary embolism (PE)), two distinct but closely related diseases, [1] constitute major public health problems and are associated with substantial morbidity, premature mortality, and high economic costs. The coronavirus disease 2019 (COVID-19) pandemic which is one of the most significant modern-day public health challenges, predominantly affects the respiratory system, causing severe pneumonia and respiratory distress syndrome. Emerging data suggests COVID-19 adversely affects multiple organs; gastrointestinal, liver, kidney, neurological and cardiac complications have been reported [2][3][4]. Apart from pre-existing comorbidities such as CVD, hypertension, chronic kidney disease, chronic liver disease and diabetes being linked to increased risk of severe illness or death; [5] some extrapulmonary complications of COVID-19 such as acute myocardial injury have been shown to be associated with fatal outcomes [6]. Recently, COVID-19 has been linked to venous and arterial thromboembolic disease (henceforth referred to as thromboembolic complications). Three recent most downloaded and key studies published in the journal reported a high incidence of thromboembolic complications in COVID-19 patients, particularly in those admitted to the intensive care unit (ICU) [7][8][9]. Given the sparseness of the data and evolving nature of the disease, the thromboembolic complications of COVID-19 and their incidence estimates are not clearly defined. There is a need for robust aggregation of data on thromboembolic complications of COVID-19, which will be of great value for policy makers, healthcare providers and clinicians to aid decision making and implementing more efficacious preventative strategies. In this context, we conducted a systematic review and meta-analysis to attempt to address the following questions: (i) what are the thromboembolic complications associated with what is the incidence of these complications overall and in those who develop severe disease?The review was conducted in accordance with PRISMA and MOOSE guidelines (Supplementary Materials 1-2). We searched MEDLINE and Embase from January 2020 to 6 August 2020 for published studies reporting on venous and arterial thromboembolic complications (e.g., VTE, PE, myocardial infarction (MI), acute coronary syndrome (ACS), ischemic stroke, disseminated intravascular coagulation (DIC)) in patients with COVID-19. Studies based on selected patients/populations (eg, cancer patients) were not included. Details of the search strategy fection. A scoping review, Thromb. Res. 192 (2020) 152-160.

Direct oral anticoagulant use and risk of severe COVID‐19

“…Coronavirus disease 2019 (COVID- 19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with hypercoagulability. Thrombosis is common in patients hospitalized with COVID-19 [1] and seems to play a key role both in the pathophysiology [2], and as incident complications [3].…”

Aorto-iliac/right leg arterial thrombosis necessitating limb amputation, pulmonary arterial, intracardiac, and ilio-caval venous thrombosis in a 40-year-old with COVID-19

“… 11 A recent meta-analysis estimates the incidence of pulmonary embolism and deep venous thrombosis in COVID-19 patients to be 14% and 12% respectively. 12 In contrast, the incidence of other thrombotic events such as systemic arterial embolism, ischemic stroke and limb ischemia are lower at 2%, 2% and 1% respectively. 12 …”

“… 12 In contrast, the incidence of other thrombotic events such as systemic arterial embolism, ischemic stroke and limb ischemia are lower at 2%, 2% and 1% respectively. 12 …”

Familial hypercholesterolaemia and COVID-19: A two-hit scenario for endothelial dysfunction amenable to treatment

“…According to a recent meta-analysis, among hospitalized COVID-19 patients, the prevalence of AMI has been 3.3% (0.3–8.5) (95% CI) and the prevalence of ischemic stroke 1.8% (1.3–2.4) (95%, CI) [ 45 ]. Only two large studies were included in this meta-analysis, and in both studies, the prevalence of ischaemic stroke and AMI was studied in parallel [ 46 , 47 ].…”