Incidence of thromboembolism in patients with COVID-19: a systematic review and meta-analysis

Abstract

Background Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, the incidence of thromboembolism has been increasingly reported. The aim of this systematic review was to explore the incidence of venous and arterial thromboembolism among COVID-19 patients requiring hospitalization. Methods Medline, Embase, Scopus, and grey literature were searched until June 2020. Observational studies reported on the incidence of venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT) or arterial thromboembolism (ATE) were included. The pool incidences and their 95% confidence intervals (CI) were calculated using the random-effects model. Results A total of 36 studies were included. In the intensive care unit (ICU) setting, the pooled incidence of VTE was 28% (95% CI, 22–34%). Subgroups based on compression ultrasound (CUS) screening revealed a higher incidence of DVT in the CUS screening group than in the no CUS screening group (32% [95% CI, 18–45%] vs. 6% [95% CI, 4–9%]). The pooled incidence of ATE in ICU was 3% (95% CI, 2–5%). In the non-ICU setting, the pooled incidence of VTE was 10% (95% CI, 6–14%,). Conclusions The incidence of VTE in COVID-19 patients was higher in the ICU setting than in the non-ICU setting, and also significantly higher in studies that incorporated the CUS screening protocol. The incidence of ATE in the ICU setting was low. VTE prophylactic measures should be given to all hospitalized patients diagnosed with COVID-19.

Superior ophthalmic vein thrombosis secondary to COVID-19: an index case

“…COVID-19 is thought to induce a systemic inflammatory response, endothelial dysfunction and a hypercoagulative state which predisposes patients to forming systemic thrombi. 5 , 6 , 7 , 8 Proposed molecular and cellular mechanisms include COVID-19 induced pyroptosis, the upregulation of platelet activation, coagulation cascade and pro-inflammatory cytokines such as interleukin-6 as well as a downregulation of fibrinolysis. [6] [8] All of the aforementioned factors are thought to be contributory to the formation of systemic emboli and/or immunothrombosis due to a delicate interplay between the immune system and haemostasis.…”

SARS-CoV-2 Infection: Modulator of Pulmonary Embolism Paradigm

“…PE was more frequent in patients admitted to the ICU than those not admitted to the ICU (24.7% vs. 10.5%) [ 27 , 28 ]. Boonyawat et al (2020), in their meta-analysis to demonstrate the pooled incidence of venous and arterial thromboembolism in COVID-19 patients in various settings, reported a pooled incidence of VTE of 28% and 10% in ICU and non-ICU settings, respectively [ 29 ]. All these studies indicate SARS-CoV-2 infection as a factor for a sudden surge in the incidence of PE the world over.…”

Arrhythmias in the Age of Coronavirus Disease 2019

“…Anticoagulation is of special importance; COVID-19 infection is associated with a hypercoagulable state and the CHA 2 DS 2 -VASc score may underestimate the stroke risk. 12 A retrospective study suggested that pulmonary embolism occurs in 24% of hospitalized COVID-19 patients and in up to 50% of those requiring intensive care. 13 This is an additional reason for prophylactic anticoagulation.…”