Mortality and risk factors associated with pulmonary embolism in coronavirus disease 2019 patients: a systematic review and meta-analysis

Abstract

To determine, in patients with coronavirus disease 2019 (COVID-19) infection, the associations of pulmonary embolism (PE) with mortality and risk factors for PE as well as the therapeutic benefit of anticoagulant prophylaxis. Embase, PubMed, Cochrane controlled trials register, and Web of Science databases were searched from inception to October 10, 2020. We included all published trials on PE in patients diagnosed with COVID-19 with eligibility of the trials assessed following the PRISMA guidelines. Sixteen clinical trials with 5826 patients were eligible. There were significant associations of PE with the male gender [odd ratio (OR) = 1.59, 95% CI 1.28–1.97], mechanical ventilation (OR = 3.71, 95% CI 2.57–5.36), intensive care unit admission (OR = 2.99, 95% CI 2.11–4.23), circulating D-dimer [mean difference (MD) = 5.04 µg/mL, 95% CI 3.67–6.42) and CRP (MD = 1.97 mg/dL, 95% CI 0.58– 3.35) concentrations without significant correlation between PE and mortality (OR = 1.31, 95% CI 0.82–2.08) as well as other parameters or comorbidities. After omitting one trial with strict patient selection criteria for anticoagulant prophylaxis, significant prophylactic benefit was noted (OR = 0.31, 95% CI 0.1–0.91). Our findings identified the risk factors associated with PE in COVID-19 patients and supported the therapeutic benefit of anticoagulant prophylaxis against PE in this patient population.

Risk of symptomatic venous thromboembolism in mild and moderate COVID-19: A comparison of two prospective European cohorts

“…This unexpected result may be explained, at least partly, by an unformal selection of patients with a high VTE risk by the physicians prescribing thromboprophylaxis and does not preclude the usefulness of thromboprophylaxis. Indeed, recent studies confirm the benefit of thromboprophylaxis in hospitalized patients with moderate COVID-19 [26]. Moreover, as compared to usual prophylactic regimens, therapeutic anticoagulation was recently proven to improve survival of moderate COVID-19 patients [27].…”

Covid-19: pharmacotherapeutic insights on various curative approaches in terms of vulnerability, comorbidities, and vaccination

“…DIC has been suggested as a critical sign of health deterioration in COVID patients leading to cardiovascular complications. DIC pathophysiology involves the endothelial cell activation, leukocytes and platelets activation, fibrin deposition leading to inflammation and coagulopathy (Al-Ani et al 2020 ; Page and Ariëns 2021 ; Gómez et al 2021 ).…”

Automated Quantitative Lung CT Improves Prognostication in Non-ICU COVID-19 Patients beyond Conventional Biomarkers of Disease

“…Recent theories on COVID-19 pathophysiology have focused on vasculitis-like anomalies or immune-mediated thrombosis in which viral alveolitis drives inflammation, endotheliopathy, and microvascular injury, leading to vascular tone dysregulation and pulmonary intravascular coagulopathy [5][6][7][8][9][10][11][12]. Postmortem reports and pathological specimens from COVID-19 patients showed DAD together with pulmonary infarction, small pulmonary vessel and capillary thrombosis, and hemorrhage [65,[67][68][69][70][71][72].…”

“…There are different reasons for clinical uncertainties and therapeutic failure in COVID-19. In fact, recent evidence has reconsidered the pathobiogenesis of COVID-19, shifting the attention from a dominant primary lung injury to all vasculitis-like anomalies and immune-mediated thrombosis [5][6][7][8][9][10][11][12].…”