Prevalence and Risk Factors of Thromboembolism among Patients With Coronavirus Disease-19: A Systematic Review and Meta-Analysis

Abstract

Emerging evidence shows that the recent pandemic of coronavirus disease 19 (COVID-19) is characterized by coagulation activation and endothelial dysfunction. This increases the risk of morbidity, mortality and economic loss among COVID-19 patients. Therefore, there was an urgent need to investigate the extent and risk factors of thromboembolism among COVID-19 patients. English-language based databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Cochrane library) were exhaustively searched to identify studies related to prevalence of thromboembolism among hospitalized COVID-19 patients. A random-effects model was employed to estimate the pooled prevalence of thromboembolism. The pooled prevalence of thrombotic events was computed using STATA 16.0 software. Heterogeneity analysis was reported using I2. A total of 19 studies with 2,520 patients with COVID-19 were included. The pooled prevalence of thrombotic events of hospitalized patients with COVID-19 was 33% (95% CI: 25-41%, I2 = 97.30%, p < 0.001) with a high degree of heterogeneity across studies. Elevated D-dimer hospitalized in the intensive care unit and being under mechanical ventilation were the most frequently associated factors for the development of thrombotic events. The pooled prevalence of thrombotic events in COVID-19 patients was 33%. The prevalence of thrombotic event is variables on the basis of study design and study centers. Several risk factors such as, elevated D-dimer, hospitalized in the intensive care unit and being under mechanical ventilation, were the most frequently reported risk factors identified. Therefore, healthcare professionals should consider these risk factors to optimally manage thromboembolism in COVID-19 patients.

Relationship of D-Dimer and Prediction of Pulmonary Embolism in Hospitalized COVID-19 Patients: A Multicenter Study

“…We observed a significantly higher respiratory rate and lower oxygen saturations on admission in patients who were PE positive compared with the negative group. Kefale et al [16] demonstrated a pooled prevalence of 33% of thrombo-embolism in hospitalized patients with COVID-19 and this was associated with elevated concentration of D-dimer. The risk of thrombo-embolism was found to be more prevalent in those who were admitted to the ICU, in keeping with our finding that PE was more prevalent in patients who were more hypoxic and had a high respiratory rate.…”

Epidemiological characteristics, clinical relevance, and risk factors of thromboembolic complications among patients with COVID-19 pneumonia at A teaching hospital: Retrospective observational study

“…Recent studies have found a significant frequency of thrombotic events in viral infections including corona-virus [ [13] , [14] , [15] ]. A meta-analysis included 8271 cases have reported thromboembolic rates in the range of 20–30% while others have reported rates as high as 40–70% [ 16 ].…”

Predictors of Venous Thromboembolism in COVID-19 Patients: Results of the COVID-19 Brazilian Registry

“…(19) Although D-dimer is also elevated in other conditions, such as sepsis, recent surgery and malignancy,(34) some studies have shown that D-dimer is an important predictor of VTE in COVID-19 patients. (9,21,25) A recent metaanalysis suggested that the traditional D-dimer cut-off value (<500 µg/L) used to exclude VTE in the general population seems applicable also to patients with COVID-19. (8) However, as a VTE risk predictor, there are still uncertainties about which levels would, in fact, predict a VTE.…”

“…(13)(14)(15)(16)) Therefore, there has been a major worldwide effort to identify predictors of VTE in hospitalized COVID-19 patients, as a path to promote prevention, early diagnosis and treatment. (8,9,(17)(18)(19) Clinical prediction scores for VTE in patients with COVID-19 are still lacking and the main available scores for clinical prediction in medical patients do not seem to perform well in patients with COVID-19. (20) Additionally, there is still a major inconsistency among the potential predictors of VTE identi ed by previous studies.…”