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Meta-Analysis
. 2020 Dec:196:67-74.
doi: 10.1016/j.thromres.2020.08.020. Epub 2020 Aug 12.

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

Angelo Porfidia  1 , Emanuele Valeriani  2 , Roberto Pola  1 , Ettore Porreca  3 , Anne W S Rutjes  4 , Marcello Di Nisio  5
Affiliations
Meta-Analysis

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

Angelo Porfidia et al. Thromb Res. 2020 Dec.

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.

Keywords: Anticoagulants; COVID-19; Pulmonary embolism; SARS virus; Venous thromboembolism.

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Conflict of interest statement

E. Valeriani, E. Porreca, A. Rutjes has nothing to disclose; A. Porfidia received personal fees and non-financial support from Boehringer Ingelheim, Daiichi Sankyo, Pfizer, Aspen, Novartis outside the submitted work; R. Pola received personal fees and non-financial support from Boehringer Ingelheim, Bayer, Daiichi Sankyo, Pfizer, Aspen, Novartis outside the submitted work; M. Di Nisio received personal fees from Bayer, Daiichi Sankyo, Pfizer, Leo Pharma, and Sanofi outside the submitted work.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram.
Fig. 2
Fig. 2
Summary risk of bias for included studies. MINORS, methodological index for non-randomized studies.
Fig. 3
Fig. 3
Incidence of venous thromboembolism in hospitalized patients with COVID-19. Grey squares indicate individual study estimates of the proportion of the outcome, grey horizontal lines indicate 95% confidence intervals of the individual studies, diamonds indicate summary estimates with 95% confidence intervals, and horizontal black lines represent 95% prediction intervals. CI, confidence intervals; COVID-19, Coronavirus disease 2019; ES, estimates; ICU, intensive care unit; NR, not reported; PI, prediction intervals; VTE, venous thromboembolism.
Fig. 4
Fig. 4
Incidence of pulmonary embolism in hospitalized patients with COVID-19. Grey squares indicate individual study estimates of the proportion of the outcome, grey horizontal lines indicate 95% confidence intervals of individual studies, diamonds indicate summary estimates with 95% confidence intervals, and horizontal black lines represent 95% prediction intervals. CI, confidence intervals; COVID-19, Coronavirus disease 2019; ES, estimates; ICU, intensive care unit; NR, not reported; PE, pulmonary embolism; PI, prediction intervals.
Fig. 5
Fig. 5
Incidence of deep vein thrombosis in hospitalized patients with COVID-19. Grey squares indicate individual study estimates of the proportion of the outcome, grey horizontal lines indicate 95% confidence intervals of the individual studies, diamonds indicate summary estimates with 95% confidence intervals, and horizontal black lines represent 95% prediction intervals. CI, confidence intervals; COVID-19, Coronavirus disease 2019; DVT, deep vein thrombosis; ES, estimates; ICU, intensive care unit; NR, not reported; PI, prediction intervals.
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