Venous thromboembolism in COVID-19 compared to non-COVID-19 cohorts: A systematic review with meta-analysis

Abstract

Background Many studies confirmed an association between COVID-19 and venous thromboembolism (VTE). Whether the risk of VTE significantly differed between COVID-19 cohorts and non-COVID-19 cohorts with similar disease severity remains unknown. Objectives The aim of this systematic review with meta-analysis was to compare the rate of VTE between COVID-19 and non-COVID-19 cohorts with similar disease severity. Methods A systematic literature search (MEDLINE, Embase and Google Scholar) was conducted from January 1, 2020 to March 31, 2021 to identify studies reporting VTE in COVID-19. Relative risks (RR) were estimated for the effect measure with 95% confidence intervals. Results Seven studies (41,768 patients) evaluated VTE in COVID-19 cohorts compared to non-COVID-19 cohorts. The overall risk of VTE (RR 1.18; 95%CI 0.79–1.77; p = 0.42; I 2 = 54%), pulmonary embolism (RR 1.25; 95%CI 0.77–2.03; p = 0.36; I 2 = 52%) and deep venous thrombosis (RR 0.92; 95%CI 0.52–1.65; p = 0.78; I 2 = 0%) did not significantly differ between COVID-19 and non-COVID-19 cohorts. However, subgroup analyses suggested an increased risk of VTE amongst CODID-19 versus non COVID-19 cohorts when only patients hospitalized within the intensive care unit (ICU) were considered (RR 3.10; 95%CI 1.54–6.23), which was not observed in cohorts of predominantly non-ICU patients (RR 0.95; 95%CI 0.81–1.11) (P interaction = 0.001). Conclusion There was no signal for a difference in VTE in COVID-19 cohorts compared to non-COVID-19 cohorts, except for the subgroup of patients hospitalized in the ICU. These results should be viewed as exploratory and further studies are needed to confirm these results.

Venous Thromboembolism in COVID-19 Compared to Non-COVID-19 Cohorts: A Systematic Review with Meta-Analysis

“…As strengths, this is the first study reporting the RD of venous thrombotic events between COVID-19 and non-COVID-19 patients. The meta-analysis by Mai et al [11] evaluated the risk ratio (RR), but that could not be applicable since there were no randomized, controlled studies on this specific topic, and based on this, we decided to evaluate the RD. Furthermore, comparing this meta-analysis with the paper by Mai et al [11], we included five more studies and 971,727 more patients.…”

“…Precipitating factors for thrombotic complications in hospitalized COVID-19 patients include inflammation, activation of the coagulation system, hypoxia, immobilization, diffuse intravascular coagulation, and endothelial dysfunction [5][6][7][8][9][10]. A higher incidence of thrombotic complications is reported in particular in COVID-19 patients admitted to the intensive care unit (ICU) [1,11]. In patients with respiratory tract infections, including influenza A virus (H1N1), many studies have demonstrated an increased incidence of thromboembolic complications [12,13], but evidence is lacking regarding the risk difference (RD) of the occurrence of venous thromboembolism (VTE) (including pulmonary embolism (PE) and deep venous thrombosis (DVT)) between COVID-19 patients and non-COVID-19 patients.…”

“…In patients with respiratory tract infections, including influenza A virus (H1N1), many studies have demonstrated an increased incidence of thromboembolic complications [12,13], but evidence is lacking regarding the risk difference (RD) of the occurrence of venous thromboembolism (VTE) (including pulmonary embolism (PE) and deep venous thrombosis (DVT)) between COVID-19 patients and non-COVID-19 patients. A recent meta-analysis documented an increased risk of VTE occurrence among COVID-19 patients hospitalized in the ICU, but no difference in risk in COVID-19 cohorts compared to non-COVID-19 cohorts [11].…”

COVID-19 Pathogenesis: From Molecular Pathway to Vaccine Administration

“…A difference was reported after analyzing the subgroups of patients who were admitted to the intensive care unit (ICU). Critically ill patients had an increased risk of VTE in the COVID-19 cohort compared to non-COVID-19 patients admitted to the ICU (RR 3.10; 95% CI 1.54–6, 23), which was not observed in cohorts of non-ICU patients (RR 0.95; 95% CI 0.81–1.11) (P interaction = 0.001) [ 62 ].…”

Current therapeutic approaches to haemostasis correction in covid-19: a systematic review

“…Однако использование гепарина и других гликозаминогликанов в качестве противовирусной терапии обладает значительным потенциалом для будущего клинического применения. Использование гепарансульфата в качестве препятствия для проникновения вируса в клетку актуально для всех коронавирусов человека, а также для вируса гепатита С и семейства герпесвирусов [20,21]. При более глубоком понимании эта терапевтическая стратегия может быть оптимизирована для COVID-19.…”