Venous Thromboembolism in Hospitalized Critical and Noncritical COVID-19 Patients: A Systematic Review and Meta-analysis

Abstract

Introduction Venous thromboembolism (VTE) has been observed as a frequent complication in patients with severe novel coronavirus disease 2019 (COVID-19) infection requiring hospital admission. Aim This study was aimed to evaluate the epidemiology of VTE in hospitalized intensive care unit (ICU) and non-ICU patients. Materials and Methods PubMed was searched up to November 13, 2020, and updated in December 12, 2020. We included studies that evaluated the epidemiology of VTE, including pulmonary embolism (PE) and/or deep vein thrombosis (DVT), in patients with COVID-19. Results A total of 91 studies reporting on 35,017 patients with COVID-19 was included. The overall frequency of VTE in all patients, ICU and non-ICU, was 12.8% (95% confidence interval [CI]: 11.103–14.605), 24.1% (95% CI: 20.070–28.280), and 7.7% (95% CI: 5.956–9.700), respectively. PE occurred in 8.5% (95% CI: 6.911–10.208), and proximal DVT occurred in 8.2% (95% CI: 6.675–9.874) of all hospitalized patients. The relative risk for VTE associated with ICU admission was 2.99 (95% CI: 2.301–3.887, p <0.001). DVT and PE estimated in studies that adopted some form of systematic screening were higher compared with studies with symptom-triggered screening. Analysis restricted to studies in the 5th quintile of sample size reported significantly lower VTE estimates. Conclusion This study confirmed a high risk of VTE in hospitalized COVID-19 patients, especially those admitted to the ICU. Nevertheless, sensitivity analysis suggests that previously reported frequencies of VTE in COVID-19 might have been overestimated.

Thromboembolic complications during and after hospitalization for COVID-19: Incidence, risk factors and thromboprophylaxis

“…Our findings are in the lower end of previously reported rates of VTE, but similar to reported rates of ATE [ 19 , 26 ]. Previously reported VTE rates for hospitalized patients with COVID-19 may be overestimated due to selected high-risk populations, reports from ICU populations, routine use of chest CT, or intensive case findings by screening asymptomatic patients for VTE.…”

“…The median (25th to 75th percentile) length of stay in the hospital was 7 days [ [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] ] overall. In total, 130 patients (23%) were admitted to the ICU, with a median length of stay in the ICU of 13 days [ [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] ] ( Table 1 ). There was a difference in sex, BMI, inflammatory biomarkers, such as CRP and D-dimer levels, length of stay, ICU admission rate and need of mechanical ventilation between the VTE and non-VTE group (all p<0.05) ( Table 1 ).…”

“…Early reports indicated very high rates of VTE up to 85% in patients admitted for COVID-19, even in patients receiving standard thromboprophylaxis, which led to suggestions of the possible need for higher prophylactic dosage [ 4 , 11 , 18 ]. Some recent studies indicate a lower incidence of thromboembolic complications than earlier studies, but reports still show a large variation [ [19] , [20] , [21] , [22] , [23] , [24] , [25] ]. In a recent meta-analysis of more than 30.000 patients, the overall incidence of VTE during hospitalization was 12.8%; 24.1% in patients admitted to the ICU, and 7.7% in non-ICU patients [ 20 ], not considering distal deep vein thrombosis (DVT).…”

Mortality of Patients Infected by COVID-19 with and without Deep-Vein Thrombosis

“…Arterial and venous thrombotic conditions are among the most serious complications of COVID-19, and the diagnosis of these conditions using Doppler ultrasound is the main form of evaluation of the extremities [13,14]. Thromboprophylaxis is mainly performed with lowmolecular-weight heparin (LMWH) and, in some specific patients, with unfractionated heparin (UFH) [15].…”

Superior Mesenteric Artery Thrombosis Following Severe COVID-19 Pneumonia

“…The spectrum of thrombotic events in COVID-19 is very broad. For example, it has been reported that up to one-third of critically ill patients with COVID-19 develop deep venous thrombosis and pulmonary embolism [1]. The thrombotic events in COVID-19 are not restricted to venous complications alone.…”