Venous thromboembolism in SARS-CoV-2 patients: only a problem in ventilated ICU patients, or is there more to it?

Criel, Maarten; Falter, Maarten; Jaeken, Jasmien; Kerrebroeck, Margaretha Van; Lefere, Isabelle; Meylaerts, L; Mesotten, Dieter; Laenen, Margot Vander; Fivez, Tom; Thomeer, Michiel; Ruttens, David

doi:10.1183/13993003.01201-2020

Cited by 55 publications

(90 citation statements)

References 21 publications

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“…For instance, MIDDELDORP et al [11], report a cumulative incidence of any venous thromboembolism (VTE) event (symptomatic or asymptomatic) of 10% at 2 weeks in a non-ICU population versus 48% in the ICU, whereas BOMPARD et al [13] report an 18% cumulative incidence of PE in non-ICU patients versus 50% in ICU. This is further supported by the study of CRIEL et al [16], also published in this edition of European Respiratory Journal, comparing deep venous thrombosis (DVT) rates between ICU patients (13%) and ward patients (4%). One obvious question is whether these rates of thrombosis are higher than we would expect?…”

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confidence: 66%

Thrombosis and COVID-19 pneumonia: the clot thickens!

et al. 2020

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confidence: 66%

Thrombosis and COVID-19 pneumonia: the clot thickens!

et al. 2020

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“…Previous analyses have estimated a significant lower incidence of acute PE in the ICU population, which generally increase in mechanically ventilated patients [34,35]. The high incidence of acute PE in critically ill patients may reflect a more severe pro-coagulant state [36][37][38][39]. Indeed, as shown by the general characteristics of the patients reviewed, both active cancer and previous venous thromboembolic events were uncommon and unlikely to explain the burden of thromboembolic complications beyond a contributing role.…”

Section: Discussionmentioning

confidence: 95%

Incidence of acute pulmonary embolism in COVID-19 patients: Systematic review and meta-analysis.

Roncon

Zuin

Valerio

et al. 2020

European Journal of Internal Medicine

125

116

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Background: Acute pulmonary embolism (PE) has been described as a frequent and prognostically relevant complication of COVID-19 infection. Aim: We performed a systematic review and meta-analysis of the in-hospital incidence of acute PE among COVID-19 patients based on studies published within four months of COVID-19 outbreak. Material and Methods: Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in abstracting data and assessing validity. We searched Medline, Scopus and Web of Science to locate all articles published up to August 1, 2020 reporting the incidence of acute PE (or lung thrombosis) in COVID-19 patients. The pooled inhospital incidence of acute PE among COVID-19 patients was calculated using a random effects model and presenting the related 95% confidence interval (CI). Statistical heterogeneity was measured using the Higgins I 2 statistic. Results: We analysed data from 7178 COVID-19 patients [mean age 60.4 years] included in twenty-three studies. Among patients hospitalized in general wards and intensive care unit (ICU), the pooled in-hospital incidence of PE (or lung thrombosis) was 14.7% of cases (95% CI: 9.9-21.3%, I 2 =95.0%, p<0.0001) and 23.4% (95% CI:16.7-31.8%, I2=88.7%, p<0.0001), respectively. Segmental/sub-segmental pulmonary arteries were more frequently involved compared to main/lobar arteries (6.8% vs18.8%, p<0.001). Computer tomography pulmonary angiogram (CTPA) was used only in 35.3% of patients with COVID-19 infection across six studies. Conclusions: The in-hospital incidence of acute PE among COVID-19 patients is higher in ICU patients compared to those hospitalized in general wards. CTPA was rarely used suggesting a potential underestimation of PE cases.

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“…Many institutions have reported an uncharacteristically high rate of VTE events in both medical ward and ICU COVID-19 patients. [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] Although there is a significant risk of deep vein thrombosis (DVT) in patients with COVID-19, some evaluations have identified a higher number of pulmonary emboli (PE) than DVT. 34.35.43,44 This discrepancy between…”

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confidence: 99%

Coagulopathy, Venous Thromboembolism, and Anticoagulation in Patients with COVID‐19

Dobesh

Trujillo

2020

Pharmacotherapy

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)has led to a worldwide pandemic, and patients with the infection are referred to as having COVID-19. Although COVID-19 is commonly considered a respiratory disease, there is clearly a thrombotic potential that was not expected. The pathophysiology of the disease and subsequent coagulopathy produce an inflammatory, hypercoagulable, and hypofibrinolytic state. Several observational studies have demonstrated surprisingly high rates of venous thromboembolism (VTE) in both general ward and intensive care patients with COVID-19. Many of these observational studies demonstrate high rates of VTE despite patients being on standard, or even higher intensity, pharmacologic VTE prophylaxis. Fibrinolytic therapy has also been used in patients with acute respiratory distress syndrome. Unfortunately, high quality randomized controlled trials are lacking. A literature search was performed to provide the most up-to-date information on the pathophysiology, coagulopathy, risk of VTE, and prevention and treatment of VTE in patients with COVID-19. These topics are reviewed in detail, along with practical issues of anticoagulant selection and duration. Although a number of international organizations have produced guideline or consensus statements, they do not all cover the same issues regarding anticoagulant therapy for patients with COVID-19, and they do not all agree. These statements and the most recent literature are combined into a list of clinical considerations that clinicians can use for the prevention and treatment of VTE in patients with COVID-19.

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Venous thromboembolism in SARS-CoV-2 patients: only a problem in ventilated ICU patients, or is there more to it?

Cited by 55 publications

References 21 publications

Thrombosis and COVID-19 pneumonia: the clot thickens!

Thrombosis and COVID-19 pneumonia: the clot thickens!

Incidence of acute pulmonary embolism in COVID-19 patients: Systematic review and meta-analysis.

Coagulopathy, Venous Thromboembolism, and Anticoagulation in Patients with COVID‐19

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