tetano
Editor, Senior Moderator
J Clin Med
. 2020 Aug 3;9(8):E2489.
doi: 10.3390/jcm9082489.
Venous Thromboembolism among Hospitalized Patients with COVID-19 Undergoing Thromboprophylaxis: A Systematic Review and Meta-Analysis
Gerald Chi[SUP] 1 [/SUP], Jane J Lee[SUP] 2 [/SUP], Adeel Jamil[SUP] 3 [/SUP], Vamsikrishna Gunnam[SUP] 1 [/SUP], Homa Najafi[SUP] 1 [/SUP], Sahar Memar Montazerin[SUP] 1 [/SUP], Fahimehalsadat Shojaei[SUP] 1 [/SUP], Jolanta Marszalek[SUP] 4 [/SUP]
Affiliations
Abstract
Background: Preliminary evidence indicates that prophylactic-dose thromboprophylaxis may be inadequate to control the increased risk of venous thromboembolism (VTE) in patients hospitalized for coronavirus disease 2019 (COVID-19) infection. Additionally, it remains unclear whether the D-dimer measurement is useful for VTE risk stratification among COVID-19 patients. This study aimed to offer benchmark data on the incidence of VTE and to examine the difference in D-dimer levels among anticoagulated COVID-19 patients with and without VTE incident.
Methods: A comprehensive literature review of PubMed from inception to May 2020 was performed for original studies that reported the frequency of VTE and death among COVID-19 patients who received thromboprophylaxis on hospitalization. The endpoints included VTE (a composite of pulmonary embolism (PE) or deep vein thrombosis (DVT)), PE, DVT, and mortality.
Results: A total of 11 cohort studies were included. Among hospitalized COVID-19 patients, 23.9% (95% confidence interval (CI), 16.2% to 33.7%; I[SUP]2[/SUP] = 93%) developed VTE despite anticoagulation. PE and DVT were detected in 11.6% (95% CI, 7.5% to 17.5%; I[SUP]2[/SUP] = 92%) and 11.9% (95% CI, 6.3% to 21.3%; I[SUP]2[/SUP] = 93%) of patients, respectively. Patients in the intensive care unit (ICU) had a higher risk for VTE (30.4% )95% CI, 19.6% to 43.9%)) than those in the ward (13.0% (95% CI, 5.9% to 26.3%)). The mortality was estimated at 21.3% (95% CI, 17.0% to 26.4%; I[SUP]2[/SUP] = 53%). COVID-19 patients who developed VTE had higher D-dimer levels than those who did not develop VTE (mean difference, 2.05 ?g/mL; 95% CI, 0.30 to 3.80 ?g/mL; P = 0.02).
Conclusions: The heightened and heterogeneous risk of VTE in COVID-19 despite prophylactic anticoagulation calls into research on the pathogenesis of thromboembolic complications and strategy of thromboprophylaxis and risk stratification. Prominent elevation of D-dimer may be associated with VTE development and can be used to identify high-risk subsets.
Keywords: COVID-19; deep vein thrombosis; pulmonary embolism; thromboprophylaxis; venous thromboembolism.
. 2020 Aug 3;9(8):E2489.
doi: 10.3390/jcm9082489.
Venous Thromboembolism among Hospitalized Patients with COVID-19 Undergoing Thromboprophylaxis: A Systematic Review and Meta-Analysis
Gerald Chi[SUP] 1 [/SUP], Jane J Lee[SUP] 2 [/SUP], Adeel Jamil[SUP] 3 [/SUP], Vamsikrishna Gunnam[SUP] 1 [/SUP], Homa Najafi[SUP] 1 [/SUP], Sahar Memar Montazerin[SUP] 1 [/SUP], Fahimehalsadat Shojaei[SUP] 1 [/SUP], Jolanta Marszalek[SUP] 4 [/SUP]
Affiliations
- PMID: 32756383
- DOI: 10.3390/jcm9082489
Abstract
Background: Preliminary evidence indicates that prophylactic-dose thromboprophylaxis may be inadequate to control the increased risk of venous thromboembolism (VTE) in patients hospitalized for coronavirus disease 2019 (COVID-19) infection. Additionally, it remains unclear whether the D-dimer measurement is useful for VTE risk stratification among COVID-19 patients. This study aimed to offer benchmark data on the incidence of VTE and to examine the difference in D-dimer levels among anticoagulated COVID-19 patients with and without VTE incident.
Methods: A comprehensive literature review of PubMed from inception to May 2020 was performed for original studies that reported the frequency of VTE and death among COVID-19 patients who received thromboprophylaxis on hospitalization. The endpoints included VTE (a composite of pulmonary embolism (PE) or deep vein thrombosis (DVT)), PE, DVT, and mortality.
Results: A total of 11 cohort studies were included. Among hospitalized COVID-19 patients, 23.9% (95% confidence interval (CI), 16.2% to 33.7%; I[SUP]2[/SUP] = 93%) developed VTE despite anticoagulation. PE and DVT were detected in 11.6% (95% CI, 7.5% to 17.5%; I[SUP]2[/SUP] = 92%) and 11.9% (95% CI, 6.3% to 21.3%; I[SUP]2[/SUP] = 93%) of patients, respectively. Patients in the intensive care unit (ICU) had a higher risk for VTE (30.4% )95% CI, 19.6% to 43.9%)) than those in the ward (13.0% (95% CI, 5.9% to 26.3%)). The mortality was estimated at 21.3% (95% CI, 17.0% to 26.4%; I[SUP]2[/SUP] = 53%). COVID-19 patients who developed VTE had higher D-dimer levels than those who did not develop VTE (mean difference, 2.05 ?g/mL; 95% CI, 0.30 to 3.80 ?g/mL; P = 0.02).
Conclusions: The heightened and heterogeneous risk of VTE in COVID-19 despite prophylactic anticoagulation calls into research on the pathogenesis of thromboembolic complications and strategy of thromboprophylaxis and risk stratification. Prominent elevation of D-dimer may be associated with VTE development and can be used to identify high-risk subsets.
Keywords: COVID-19; deep vein thrombosis; pulmonary embolism; thromboprophylaxis; venous thromboembolism.