Clinical Characteristics and Outcomes of Venous Thromboembolism in Patients Hospitalized for COVID-19: Systematic Review and Meta-Analysis

Abstract

Objective: To investigate the clinical characteristics and outcomes of Coronavirus Disease of 2019 (COVID-19) patients complicated with venous thromboembolism (VTE) Method: We performed a comprehensive literature search of several databases to find studies that assessed VTE in hospitalized COVID-19 patients with a primary outcome of all-cause mortality and secondary outcomes of intensive care unit (ICU) admission and mechanical ventilation. We also evaluated the clinical characteristics of VTE sufferers. Objective: To investigate the clinical characteristics and outcomes of Coronavirus Disease of 2019 (COVID-19) patients complicated with venous thromboembolism (VTE) Method: We performed a comprehensive literature search of several databases to find studies that assessed VTE in hospitalized COVID-19 patients with a primary outcome of all-cause mortality and secondary outcomes of intensive care unit (ICU) admission and mechanical ventilation. We also evaluated the clinical characteristics of VTE sufferers. Results: Eight studies have been included with a total of 1237 pooled subjects. Venous thromboembolism was associated with higher mortality (RR 2.48 (1.35, 4.55), p=0.003; I2 5%, p=0.35) after we performed sensitivity analysis, ICU admission (RR 2.32 (1.53, 3.52), p<0.0001; I2 80%, p <0.0001), and mechanical ventilation need (RR 2.73 (1.56, 4.78), p=0.0004; I2 77%, p=0.001). Furthermore, it was also associated to male gender (RR 1.21 (1.08, 1.35), p=0.0007; I2 12%, p=0.34), higher white blood cells count (MD 1.24 (0.08, 2.41), 0.04; I2 0%; 0.26), D-dimer (MD 4.49 (2.74, 6.25), p<0.00001; I2 67%, p=0.009) and LDH levels (MD 70.93 (19.33, 122.54), p<0.007; I2 21%, p=0.28). In addition, after sensitivity analysis was conducted, VTE also associated with older age (MD 2.79 (0.06, 5.53), p=0.05; I2 25%, p=0.24) and higher CRP levels (MD 2.57 (0.88, 4.26); p=0.003; I2 0%, p=0.96). Conclusion: Venous thromboembolism in COVID-19 patients was associated with increased mortality, ICU admission, and mechanical ventilation requirement. Male gender, older age, higher levels of biomarkers, including WBC count, D-Dimer, and LDH were also being considerably risks for developing VTE in COVID-19 patients during hospitalization. Conclusion: Venous thromboembolism in COVID-19 patients was associated with increased mortality, ICU admission, and mechanical ventilation requirement. Male gender, older age, higher levels of biomarkers, including WBC count, D-Dimer, and LDH were also being considerably risks for developing VTE in COVID-19 patients during hospitalization.

Systematic Review of Microthrombi in COVID-19 Autopsies

“…The presence of deep venous thrombosis has been associated with a higher rate of admissions to the intensive care unit ( p = 0005) and more deaths ( p = 0.001) [ 54 ]. In the meta-analysis conducted by Henrina et al [ 55 ], which included 1,237 subjects, they found that venous thromboembolism in patients hospitalized was associated with higher mortality (RR 2.48 [1.35, 4.55], p = 0.003), intensive care unit admission (RR 2.32 [1.35, 4.55], p < 0.0001), and mechanical ventilation (RR 2.73 [1.56, 4.78], p = 0.001). The presence of macrothrombi has also been reported in the cerebral venous sinus [ 56 ], prostatic venous plexus [ 28 , 53 ], esophageal veins [ 53 ], liver central vein [ 57 ], arterial thrombosis in the spleen [ 33 ], abdominal aorta [ 58 ], aortoiliac, low inguinal, upper limb vessels [ 59 ], and testis [ 12 , 33 ].…”

Pulmonary embolism rate in patients infected with SARS-CoV-2

“…An early study of patients with COVID-19 in the intensive care unit (ICU) demonstrated a 31% rate of venous thrombosis, 85% of which was PE [2]. A meta-analysis by Henrina et al analyzed 1,237 pooled patients from eight studies and found that venous thromboembolism was associated with higher mortality, need for ICU admission, and mechanical ventilation [3]. To better understand the incidence of PE in a more general population of patients with upper respiratory symptoms suspicious of COVID-19 infection or PE, we studied the incidence of pulmonary embolism in patients presenting to our institution with upper respiratory symptoms during the height of the pandemic.…”

COVID-19 in 2021 “the end of the beginning”

“…Indeed, incidence of VTE seems to be associated with ICU admission and mechanical ventilation. As described by Henrinaa and colleagues, male gender, WBC and neutrophil count, NLR, D-Dimer, LDH, and CRP, prolonged PT, and lower albumin levels are found to be associated with prothrombotic risk in ICU population [ 7 ].…”