Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis

Abstract

Background: Studies have suggested that there is increased risk of thromboembolism (TE) associated with coronavirus disease 2019 (COVID-19). However, overall arterial and venous TE rates of COVID-19 and effect of TE on COVID-19 mortality is unknown.

Methods: We did a systematic review and meta-analysis of studies evaluating TE in COVID-19. We searched PubMed, Cochrane, and Embase for studies published up to June 12, 2020. Random effects models were used to produce summary TE rates and odds ratios (OR) of mortality in COVID-19 patients with TE compared to those without TE. Heterogeneity was quantified with I ² .

Findings: Of 425 studies identified, 42 studies enrolling 8271 patients were included in the meta-analysis. Overall venous TE rate was 21% (95% CI:17-26%): ICU, 31% (95% CI: 23-39%). Overall deep vein thrombosis rate was 20% (95% CI: 13-28%): ICU, 28% (95% CI: 16-41%); postmortem, 35% (95% CI:15-57%). Overall pulmonary embolism rate was 13% (95% CI: 11-16%): ICU, 19% (95% CI:14-25%); postmortem, 22% (95% CI:16-28%). Overall arterial TE rate was 2% (95% CI: 1-4%): ICU, 5% (95%CI: 3-7%). Pooled mortality rate among patients with TE was 23% (95%CI:14-32%) and 13% (95% CI:6-22%) among patients without TE. The pooled odds of mortality were 74% higher among patients who developed TE compared to those who did not (OR, 1.74; 95%CI, 1.01-2.98; P = 0.04).

Interpretation: TE rates of COVID-19 are high and associated with higher risk of death. Robust evidence from ongoing clinical trials is needed to determine the impact of thromboprophylaxis on TE and mortality risk of COVID-19.

Funding: None.

Keywords: Arterial thromboembolism; Covid-19; Deep vein thrombosis; Pulmonary embolism; Venous thromboembolism.

Fig. 1

Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow chart of study selection.

Fig. 2

Venous thromboembolism rates. A. Overall; B. Deep vein thrombosis; C. Pulmonary embolism. Abbreviation: ICU, intensive care unit.

Fig. 2

Venous thromboembolism rates. A. Overall; B. Deep vein thrombosis; C. Pulmonary embolism. Abbreviation: ICU, intensive care unit.

Fig. 3

Arterial thromboembolism rates. A. Overall; B. Myocardial infarction; C. Cerebrovascular accident; D. Acute limb ischemia. Abbreviation: ICU, intensive care unit.

Fig. 4

Mortality among patients with and without thromboembolism. A. Mortality rate of patients with thromboembolism; B. Mortality rate of patients without thromboembolism; C. Pooled odds of mortality among patients with TE compared to patients without TE. Abbreviation: TE, thromboembolism.