Differences Between Surviving and Non-surviving Venous Thromboembolism COVID-19 Patients: A Systematic Review

Abstract

Background: Systematic reviews of venous thromboembolism COVID-19 patients focus on the incidence, primary and secondary venous thromboembolism prevention, bleeding complications, and the association of D-dimer with mortality. We analyzed therapeutic approaches, outcomes, clinical presentation, risk stratification, and patient characteristics that survived and did not survive.Methods: We searched for systematic reviews, cohorts, case series, case reports, editor letters, and venous thromboembolism COVID-19 patients' abstracts following PRISMA and PROSPERO statements. The objective was to assess therapeutic trends and clinical outcomes of venous thromboembolism COVID-19 patients. Inclusion: COVID-19 patients with venous thromboembolism confirmed by an imaging method (venous doppler ultrasound, ventilation-perfusion lung scan, computed tomography pulmonary angiogram, pulmonary angiography). We assessed the original Pulmonary Embolism Severity Index in two groups, survivors and those who died. We defined major bleedings according to the International Society of Thrombosis and Haemostasis criteria.Results: We performed a systematic review from August 9 to August 30, 2020. We collected 1,535 papers from PubMed, Scopus, Web of Science, Wiley, and Opengrey. We extracted data from 89 studies. Unfractionated and low-molecular-weight heparin drove parenteral anticoagulation. The Food and Drug Administration-approved alteplase regimen guided the advanced treatment in both groups. The mortality was high (21.6%), with a low incidence of bleeding complications in those who survived: Pulmonary Embolism Severity Index class II and III identified patients who lived. Patients who experienced venous thromboembolism events at home were more likely to live than in-hospital events. Patients who died had a higher D dimer expression and right ventricular dysfunction.Conclusions: We determined a high mortality incidence of pulmonary embolism (21.6%) related to hypertension, an increased inflammatory response, prothrombotic state, severe COVID-19, massive pulmonary embolism, intensive care unit admission, low venous thromboembolism prophylaxis, and bleeding complications. The original Pulmonary Embolism Severity Index could be helpful in the risk stratification. Overlapping severe COVID-19 pneumonia and pulmonary embolism is a challenge.