Prevalence of Venous Thromboembolism in Critically Ill COVID-19 Patients: Systematic Review and Meta-Analysis

Mouhand F H Mohamed; Shaikha D Al-Shokri; Khaled M Shunnar; Sara F Mohamed; Mostafa S Najim; Shahd I Ibrahim; Hazem Elewa; Lina O Abdalla; Ahmed El-Bardissy; Mohamed Nabil Elshafei; Ibrahim Y Abubeker; Mohammed Danjuma; Khalid M Dousa; Mohamed A Yassin

doi:10.3389/fcvm.2020.598846

Prevalence of Venous Thromboembolism in Critically Ill COVID-19 Patients: Systematic Review and Meta-Analysis

Front Cardiovasc Med. 2021 Jan 8:7:598846. doi: 10.3389/fcvm.2020.598846. eCollection 2020.

Authors

Affiliations

¹ Department of Medicine, Hamad Medical Corporation, Doha, Qatar.
² College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
³ Clinical Pharmacy Department, Hamad General Hospital, Doha, Qatar.
⁴ Alpert Medical School, Brown University, Providence, RI, United States.
⁵ College of Medicine, QU Health, Qatar University, Doha, Qatar.
⁶ Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States.
⁷ Department of Hematology, Hamad Medical Corporation, Doha, Qatar.

Abstract

Background: Recent studies revealed a high prevalence of venous thromboembolism (VTE) events in coronavirus disease 2019 (COVID-19) patients, especially in those who are critically ill. Available studies report varying prevalence rates. Hence, the exact prevalence remains uncertain. Moreover, there is an ongoing debate regarding the appropriate dosage of thromboprophylaxis. Methods: We performed a systematic review and proportion meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed and EMBASE for studies exploring the prevalence of VTE in critically ill COVID-19 patients till 25/07/2020. We pooled the proportion of VTE. Additionally, in a subgroup analysis, we pooled VTE events detected by systematic screening. Finally, in an exploratory analysis, we compared the odds of VTE in patients on prophylactic compared with therapeutic anticoagulation. Results: The review comprised 24 studies and over 2,500 patients. The pooled proportion of VTE prevalence was 0.31 [95% confidence interval (CI) 0.24, 0.39; I ² 94%], of VTE utilizing systematic screening was 0.48 (95% CI 0.33, 0.63; I ² 91%), of deep venous thrombosis was 0.23 (95% CI 0.14, 0.32; I ² 96%), and of pulmonary embolism was 0.14 (95% CI 0.09, 0.20; I ² 90%). Exploratory analysis of few studies, utilizing systematic screening, VTE risk increased significantly with prophylactic, compared with therapeutic anticoagulation [odds ratio (OR) 5.45; 95% CI 1.90, 15.57; I ² 0%]. Discussion: Our review revealed a high prevalence of VTE in critically ill COVID-19 patients. Almost 50% of patients had VTE detected by systematic screening. Higher thromboprophylaxis dosages may reduce VTE burden in this patient's cohort compared with standard prophylactic anticoagulation; however, this is to be ascertained by ongoing randomized controlled trials.

Keywords: COVID-19; DVT—deep vein thrombosis; ICU; SARS-CoV-2; VTE; thrombosis; venous.

Publication types

Systematic Review