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Venous thromboembolism in patients with COVID-19: Systematic review and meta-analysis
Angelo Porfidia1, Emanuele Valeriani2, Roberto Pola1
1Division of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Insights
Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is a frequent complication in hospitalized Coronavirus Disease 2019 (COVID-19) patients. Prompt diagnostic testing is recommended due to the high incidence of VTE in these patients.
Area of Science:
- Medical research
- Clinical epidemiology
- Infectious diseases
Background:
- Coronavirus Disease 2019 (COVID-19) is associated with an increased risk of venous thromboembolism (VTE).
- Understanding the incidence of VTE in COVID-19 patients is crucial for clinical management.
Purpose of the Study:
- To evaluate the incidence of VTE, including pulmonary embolism (PE) and deep vein thrombosis (DVT), in patients with COVID-19.
Main Methods:
- A systematic literature search was conducted across MEDLINE, EMBASE, and PubMed up to June 24, 2020.
- Random-effect meta-analysis was used to calculate pooled proportions of VTE, PE, and DVT.
- 30 studies comprising 3487 COVID-19 patients were included in the analysis.
Main Results:
- The overall incidence of VTE in COVID-19 patients was 26% (95% PI, 6%-66%), based on low-quality evidence.
- Pulmonary embolism (PE) occurred in 12% (95% PI, 2%-46%) and deep vein thrombosis (DVT) alone in 14% (95% PI, 1%-75%).
- VTE incidence was higher in intensive care unit (ICU) patients (24%) compared to those in general wards (9%).
Conclusions:
- Venous thromboembolism (VTE) is a frequent complication in hospitalized COVID-19 patients, often presenting as PE.
- A low threshold for clinical suspicion is warranted to initiate timely diagnostic evaluation for VTE.
- These findings underscore the importance of vigilance for VTE in the COVID-19 patient population.
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.
