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Venous thromboembolism in COVID-19: A systematic review and meta-analysis

Anastasios Kollias1, Konstantinos G Kyriakoulis1, Styliani Lagou1

  • 1Third Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Hospital, Athens, Greece.

Vascular Medicine (London, England)
|April 5, 2021
PubMed

Insights

Patients with severe COVID-19 face a high risk of venous thromboembolism (VTE) events, including deep vein thrombosis and pulmonary embolism, even with prophylactic anticoagulation. This risk is elevated in intensive care unit patients and those with higher D-dimer levels.

Area of Science:

  • Medical research
  • Cardiology
  • Pulmonology
  • Infectious diseases

Background:

  • Severe coronavirus disease 2019 (COVID-19) is linked to an increased incidence of venous thromboembolism (VTE) events.
  • Understanding the prevalence of VTE in COVID-19 patients is crucial for risk stratification and management.
  • Prophylactic anticoagulation is commonly used, but its effectiveness in preventing VTE in severe COVID-19 requires evaluation.

Purpose of the Study:

  • To systematically review and synthesize the prevalence of VTE (deep vein thrombosis [DVT] and pulmonary embolism [PE]) in patients with COVID-19.
  • To identify factors associated with VTE prevalence in this population.
  • To assess the association between VTE and mortality in COVID-19 patients.

Main Methods:

  • A systematic review of PubMed/EMBASE was conducted for studies reporting VTE prevalence in COVID-19 patients screened for DVT and/or PE.
  • Pooled estimates for PE and DVT prevalence were calculated using meta-analysis.
  • Meta-regression analysis explored factors influencing VTE prevalence, and the odds ratio for death in VTE patients was determined.

Main Results:

  • The pooled prevalence of PE was 32% (95% CI: 25, 40%) and DVT was 27% (95% CI: 21, 34%) across the included studies.
  • VTE prevalence was higher in studies with more intensive care unit (ICU) patients and higher mean D-dimer levels.
  • The pooled odds ratio for death in COVID-19 patients with VTE was 2.1 (95% CI: 1.2, 3.6) compared to those without VTE.

Conclusions:

  • Hospitalized patients with severe COVID-19 exhibit a high risk of VTE, even when receiving prophylactic anticoagulation.
  • Factors such as ICU admission and elevated D-dimer levels are associated with increased VTE risk.
  • Further research is needed to determine individualized VTE risk and optimize preventive antithrombotic strategies for COVID-19 patients.

Keywords:
SARS-CoV-2deep vein thrombosis (DVT)prevalencepulmonary embolism (PE)

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