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

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

Anastasios Kollias  1 , Konstantinos G Kyriakoulis  1 , Styliani Lagou  1 , Evangelos Kontopantelis  2   3 , George S Stergiou  1 , Konstantinos Syrigos  1
Affiliations
Meta-Analysis

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

Anastasios Kollias et al. Vasc Med. 2021 Aug.

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).

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Conflict of interest statement

Declaration of conflicting interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow chart for the selection of studies.
Figure 2.
Figure 2.
Forest plot of prevalence of pulmonary embolism in patients with coronavirus disease (COVID-19). BDL, Bootstrapped DerSimonian-Laird’ model.
Figure 3.
Figure 3.
Forest plot of prevalence of deep vein thrombosis in patients with coronavirus disease (COVID-19). BDL, Bootstrapped DerSimonian-Laird’ model.
Figure 4.
Figure 4.
Forest plot of odds ratios for death in patients with COVID-19 and VTE versus those without VTE. COVID-19, coronavirus disease 2019; VTE, venous thromboembolism.
See this image and copyright information in PMC

Comment in

References

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