Venous thromboembolism in patients with COVID-19: Systematic review and meta-analysis

Abstract

Background Venous thromboembolism (VTE) may complicate the course of Coronavirus Disease 2019 (COVID-19). Objectives To evaluate the incidence of VTE in patients with COVID-19. Methods MEDLINE, EMBASE, and PubMed were searched up to 24th June 2020 for studies that evaluated the incidence of VTE, including pulmonary embolism (PE) and/or deep vein thrombosis (DVT), in patients with COVID-19. Pooled proportions with corresponding 95% confidence intervals (CI) and prediction intervals (PI) were calculated by random-effect meta-analysis. Results 3487 patients from 30 studies were included. Based on very low-quality evidence due to heterogeneity and risk of bias, the incidence of VTE was 26% (95% PI, 6%–66%). PE with or without DVT occurred in 12% of patients (95% PI, 2%–46%) and DVT alone in 14% (95% PI, 1%–75%). Studies using standard algorithms for clinically suspected VTE reported PE in 13% of patients (95% PI, 2%–57%) and DVT in 6% (95% PI, 0%–60%), compared to 11% (95% PI, 2%–46%) and 24% (95% PI, 2%–85%) in studies using other diagnostic strategies or patient sampling. In patients admitted to intensive care units, VTE occurred in 24% (95% PI, 5%–66%), PE in 19% (95% PI, 6%–47%), and DVT alone in 7% (95% PI, 0%–69%). Corresponding values in general wards were respectively 9% (95% PI, 0%–94%), 4% (95% PI, 0%–100%), and 7% (95% CI, 1%–49%). Conclusions VTE represents a frequent complication in hospitalized COVID-19 patients and often occurs as PE. The threshold for clinical suspicion should be low to trigger prompt diagnostic testing.

Bowel necrosis associated with COVID-19 pneumonia: A report of two cases

“…The incidence of VTE has increased in patients admitted for Covid-19, and further imaging may be recommended for low suspicion of VTE [5] .…”

COVID-19 vasculitis and novel vasculitis mimics

“…Commonly recognised systemic venous thrombotic states in COVID-19 pneumonia are deep vein thrombosis and extensive pulmonary thromboembolism. 39 , 40 This venous-centred thrombosis seems to be very common in patients with severe COVID-19 who are on ventilators in intensive care. 41 …”

<p>D-Dimer, Fibrinogen, and IL-6 in COVID-19 Patients with Suspected Venous Thromboembolism: A Narrative Review</p>

“…21 These results were matching to a recent meta-analysis that investigated the risk of VTE in COVID-19 patients found that the incidence of VTE is 26%, while DVT and PE were 12% and 14%, respectively. 22 A study that investigated patients from 2 leading hospitals in Wuhan, China found that out of 184 ICU patients, just more than a courter (27%) developed VTE, while less than 5% of patients developed arterial Thromboembolism (TE). 5 In the same line, Middeldorp et al 23 showed DVT has been formed in the same percentage (27%) of ICU and 1.6% of non-ICU patients with COVID-19.…”