tetano
Editor, Senior Moderator
Thromb Res
. 2020 Aug 12;196:67-74.
doi: 10.1016/j.thromres.2020.08.020. Online ahead of print.
Venous thromboembolism in patients with COVID-19: Systematic review and meta-analysis
Angelo Porfidia[SUP] 1 [/SUP], Emanuele Valeriani[SUP] 2 [/SUP], Roberto Pola[SUP] 1 [/SUP], Ettore Porreca[SUP] 3 [/SUP], Anne W S Rutjes[SUP] 4 [/SUP], Marcello Di Nisio[SUP] 5 [/SUP]
Affiliations
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.
. 2020 Aug 12;196:67-74.
doi: 10.1016/j.thromres.2020.08.020. Online ahead of print.
Venous thromboembolism in patients with COVID-19: Systematic review and meta-analysis
Angelo Porfidia[SUP] 1 [/SUP], Emanuele Valeriani[SUP] 2 [/SUP], Roberto Pola[SUP] 1 [/SUP], Ettore Porreca[SUP] 3 [/SUP], Anne W S Rutjes[SUP] 4 [/SUP], Marcello Di Nisio[SUP] 5 [/SUP]
Affiliations
- PMID: 32853978
- DOI: 10.1016/j.thromres.2020.08.020
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.