Prevalence of Venous Thromboembolism in Critically-ill COVID-19 Patients: Systematic Review and Meta-analysis

Abstract

Background: Recent studies revealed a high prevalence of venous thromboembolism (VTE) events in coronavirus disease 2019 (COVID-19) patients, especially in those who are critically ill. Available studies report varying prevalence rates. Hence, the exact prevalence remains uncertain. Moreover, there is an ongoing debate regarding the appropriate dosage of thromboprophylaxis. Methods: We performed a systematic review and proportion meta-analysis following PRISMA guidelines. We searched PubMed and EMBASE for studies exploring the prevalence of VTE in critically ill COVID-19 patients till 22/07/2020. We pooled the proportion of VTE. Additionally, in a subgroup analysis, we pooled VTE events detected by systematic screening. Finally, we compared the odds of VTE in patients on prophylactic compared to therapeutic anticoagulation. Results: The review comprised of 24 studies and over 2500 patients. The pooled proportion of VTE prevalence was 0.31 (95% CI 0.24, 0.39 I2 94%), of VTE utilizing systematic screening was 0.48 (95% CI 0.33, 0.63 I2 91%), of deep-venous-thrombosis was 0.23 (95% CI 0.14, 0.32 I2 96%), of pulmonary embolism was 0.14 (95% CI 0.09, 0.20 I2 90%). In a subgroup of studies, utilizing systematic screening, VTE risk increased significantly with prophylactic, compared to therapeutic anticoagulation (OR 5.45; 95% CI 1.90, 15.57 I2 0%). Discussion: Our review revealed a high prevalence of VTE in critically ill COVID-19 patients. Almost 50% of patients had VTE detected by systematic screening. Higher thromboprophylaxis dosages seem to reduce VTE burden in this patient's cohort compared to standard prophylactic anticoagulation; ongoing randomized controlled trials will further confirm this.

Anticoagulants and Antiplatelets in COVID-19: Impact on Survival and Thromboembolism Development

“…The observation that there is no statistically significant difference in thromboembolism development between patients using warfarin, DOACs, and those not taking therapeutic anticoagulation is in line with some other cohort studies [15,16]. It does not align with the findings of numerous studies conducted in critically-ill patients [14,37–39], which found decreased incidence of thromboembolism in patients using therapeutic anticoagulation. This is likely a reflection of the differing severity of illness between study populations.…”

“…Conclusions of research on the impact of anticoagulant therapy on thromboembolism in COVID-19 positive patients has been similarly mixed. Some have found venous thromboembolic risk in critically-ill patients with COVID-19 infection to be significantly higher with prophylactic anticoagulation when compared with therapeutic anticoagulation [14], whereas some retrospective cohort studies have found no statistically significant difference in thrombosis development between groups receiving prophylactic anticoagulation, therapeutic anticoagulation, and intermediate doses [15,16]. However, much of this research is limited to patients admitted to critical care, or studied relatively small populations.…”

SARS‐CoV‐2 and guttate psoriasis: A case report and review of literature

“…The respiratory symptoms were mild, the chest X‐ray was unremarkable, and she did not develop any thrombotic complications. 17 Despite that, she had severe skin eruption supporting the reported fact that skin rash with SARS‐CoV‐2 has no relation to the severity of the respiratory symptoms. The SARS‐CoV‐2 virus may cause the eruption of guttate psoriasis by a similar mechanism to streptococcal infection by molecular mimicry, or the cytokine excess might cause it during the acute infection.…”

COVID‐19 in a pregnant patient with beta‐thalassemia major: A case report

“…Thrombosis is a major complication of COVID‐19 infection, and the placenta is not immune. 28 Whether the early ischemic changes in the report are linked to COVID‐19 infection is uncertain and is debatable.…”