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

Vasc Med. 2021 Aug;26(4):415-425. doi: 10.1177/1358863X21995566. Epub 2021 Apr 4.

Abstract

Severe coronavirus disease 2019 (COVID-19) is associated with increased risk of venous thromboembolism events (VTE). This study performed a systematic review in PubMed/EMBASE of studies reporting the prevalence of VTE in patients with COVID-19 who were totally screened/assessed for deep vein thrombosis (DVT) and/or for pulmonary embolism (PE). Among 47 candidate studies (n = 6459; 33 in Europe), 17 studies (n = 3973; weighted age 63.0 years, males 60%, intensive care unit (ICU) 16%) reported the prevalence of PE with a pooled estimate of 32% (95% CI: 25, 40%), and 32 studies (n = 2552; weighted age 62.6 years, males 57%, ICU 49%) reported the prevalence of DVT with a pooled estimate of 27% (95% CI: 21, 34%). A total of 36 studies reported the use of at least prophylactic antithrombotic treatment in the majority of their patients. Meta-regression analysis showed that the prevalence of VTE was higher across studies with a higher percentage of ICU patients and higher study population mean D-dimer values, and lower in studies with mixed dosing of anticoagulation in ⩾ 50% of the population compared to studies with standard prophylactic dosing of anticoagulation in < 50% of the population. The pooled odds ratio for death in patients with COVID-19 and VTE versus those without VTE (17 studies, n = 2882) was 2.1 (95% CI: 1.2, 3.6). Hospitalized patients with severe COVID-19 are at high VTE risk despite prophylactic anticoagulation. Further research should investigate the individualized VTE risk of patients with COVID-19 and the optimal preventive antithrombotic therapy. PROSPERO Registration No.: CRD42020185543.

Keywords: SARS-CoV-2; deep vein thrombosis (DVT); prevalence; pulmonary embolism (PE).

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • COVID-19 / diagnosis
  • COVID-19 / epidemiology*
  • COVID-19 / mortality
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Prognosis
  • Pulmonary Embolism / diagnosis
  • Pulmonary Embolism / epidemiology*
  • Pulmonary Embolism / mortality
  • Risk Assessment
  • Risk Factors
  • Venous Thromboembolism / diagnosis
  • Venous Thromboembolism / epidemiology*
  • Venous Thromboembolism / mortality
  • Venous Thrombosis / diagnosis
  • Venous Thrombosis / epidemiology*
  • Venous Thrombosis / mortality
  • Young Adult