Elsevier

Thrombosis Research

Volume 196, December 2020, Pages 67-74
Thrombosis Research

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

https://doi.org/10.1016/j.thromres.2020.08.020Get rights and content

Highlights

  • Incidence of venous thromboembolism (VTE) in Coronavirus Disease-2019 (COVID-19) is unclear.

  • A total of 3487 patients with COVID-19 were included in 30 observational studies.

  • VTE incidence varied due to differences in diagnostic protocols and hospital setting.

  • VTE risk was higher in intensive care units, but seemed also substantial in general wards despite prophylaxis.

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

Cited by (0)

1

These authors share co-first authorship.

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