Incidence of VTE and Bleeding Among Hospitalized Patients With Coronavirus Disease 2019: A Systematic Review and Meta-analysis.
COVID-19
DVT
VTE
bleeding
pulmonary embolism
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
16
09
2020
revised:
31
10
2020
accepted:
05
11
2020
pubmed:
21
11
2020
medline:
17
3
2021
entrez:
20
11
2020
Statut:
ppublish
Résumé
Individual studies have reported widely variable rates for VTE and bleeding among hospitalized patients with coronavirus disease 2019 (COVID-19). What is the incidence of VTE and bleeding among hospitalized patients with COVID-19? In this systematic review and meta-analysis, 15 standard sources and COVID-19-specific sources were searched between January 1, 2020, and July 31, 2020, with no restriction according to language. Incidence estimates were pooled by using random effects meta-analyses. Heterogeneity was evaluated by using the I The pooled incidence was 17.0% (95% CI, 13.4-20.9) for VTE, 12.1% (95% CI, 8.4-16.4) for DVT, 7.1% (95% CI, 5.3-9.1) for pulmonary embolism (PE), 7.8% (95% CI, 2.6-15.3) for bleeding, and 3.9% (95% CI, 1.2-7.9) for major bleeding. In subgroup meta-analyses, the incidence of VTE was higher when assessed according to screening (33.1% vs 9.8% by clinical diagnosis), among patients in the ICU (27.9% vs 7.1% in the ward), in prospective studies (25.5% vs 12.4% in retrospective studies), and with the inclusion of catheter-associated thrombosis/isolated distal DVTs and isolated subsegmental PEs. The highest pooled incidence estimate of bleeding was reported for patients receiving intermediate- or full-dose anticoagulation (21.4%) and the lowest in the only prospective study that assessed bleeding events (2.7%). Among hospitalized patients with COVID-19, the overall estimated pooled incidence of VTE was 17.0%, with higher rates with routine screening, inclusion of distal DVT, and subsegmental PE, in critically ill patients and in prospective studies. Bleeding events were observed in 7.8% of patients and were sensitive to use of escalated doses of anticoagulants and nature of data collection. Additional studies are required to ascertain the significance of various thrombotic events and to identify strategies to improve patient outcomes. PROSPERO; No.: CRD42020198864; URL: https://www.crd.york.ac.uk/prospero/.
Sections du résumé
BACKGROUND
Individual studies have reported widely variable rates for VTE and bleeding among hospitalized patients with coronavirus disease 2019 (COVID-19).
RESEARCH QUESTION
What is the incidence of VTE and bleeding among hospitalized patients with COVID-19?
METHODS
In this systematic review and meta-analysis, 15 standard sources and COVID-19-specific sources were searched between January 1, 2020, and July 31, 2020, with no restriction according to language. Incidence estimates were pooled by using random effects meta-analyses. Heterogeneity was evaluated by using the I
RESULTS
The pooled incidence was 17.0% (95% CI, 13.4-20.9) for VTE, 12.1% (95% CI, 8.4-16.4) for DVT, 7.1% (95% CI, 5.3-9.1) for pulmonary embolism (PE), 7.8% (95% CI, 2.6-15.3) for bleeding, and 3.9% (95% CI, 1.2-7.9) for major bleeding. In subgroup meta-analyses, the incidence of VTE was higher when assessed according to screening (33.1% vs 9.8% by clinical diagnosis), among patients in the ICU (27.9% vs 7.1% in the ward), in prospective studies (25.5% vs 12.4% in retrospective studies), and with the inclusion of catheter-associated thrombosis/isolated distal DVTs and isolated subsegmental PEs. The highest pooled incidence estimate of bleeding was reported for patients receiving intermediate- or full-dose anticoagulation (21.4%) and the lowest in the only prospective study that assessed bleeding events (2.7%).
INTERPRETATION
Among hospitalized patients with COVID-19, the overall estimated pooled incidence of VTE was 17.0%, with higher rates with routine screening, inclusion of distal DVT, and subsegmental PE, in critically ill patients and in prospective studies. Bleeding events were observed in 7.8% of patients and were sensitive to use of escalated doses of anticoagulants and nature of data collection. Additional studies are required to ascertain the significance of various thrombotic events and to identify strategies to improve patient outcomes.
TRIAL REGISTRY
PROSPERO; No.: CRD42020198864; URL: https://www.crd.york.ac.uk/prospero/.
Identifiants
pubmed: 33217420
pii: S0012-3692(20)35146-1
doi: 10.1016/j.chest.2020.11.005
pmc: PMC7670889
pii:
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1182-1196Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
Références
Thromb Res. 2020 Aug;192:23-26
pubmed: 32405101
Thromb Res. 2020 Sep;193:1-4
pubmed: 32485437
Radiology. 2020 Sep;296(3):E186-E188
pubmed: 32324103
J Thromb Haemost. 2020 Jul;18(7):1559-1561
pubmed: 32302453
J Thromb Thrombolysis. 2020 Oct;50(3):558-566
pubmed: 32617807
Clin Appl Thromb Hemost. 2020 Jan-Dec;26:1076029620936772
pubmed: 32726134
Eur Respir J. 2020 Jul 30;56(1):
pubmed: 32398294
Clin Microbiol Infect. 2020 Nov;26(11):1572-1573
pubmed: 32565320
Thromb Haemost. 2020 Jul;120(7):1004-1024
pubmed: 32473596
Stat Med. 2002 Jun 15;21(11):1539-58
pubmed: 12111919
Curr Probl Cardiol. 2020 Aug;45(8):100618
pubmed: 32439197
Clin Respir J. 2022 Mar;16(3):182-189
pubmed: 35060325
Autoimmun Rev. 2020 Jul;19(7):102568
pubmed: 32376398
Thromb Res. 2020 Sep;193:166-169
pubmed: 32707275
Semin Thromb Hemost. 2021 Jun;47(4):351-361
pubmed: 33086403
Circulation. 2020 Jul 14;142(2):181-183
pubmed: 32412320
TH Open. 2020 Jun 08;4(2):e113-e115
pubmed: 32529170
J Thromb Thrombolysis. 2021 Jan;51(1):40-46
pubmed: 32613385
Eur Heart J. 2020 Jul 1;41(32):3058-3068
pubmed: 32656565
J Thromb Haemost. 2020 Jun;18(6):1421-1424
pubmed: 32271988
J Thromb Haemost. 2020 Jul;18(7):1743-1746
pubmed: 32320517
J Thromb Thrombolysis. 2020 Jul;50(1):211-216
pubmed: 32451823
J Clin Epidemiol. 2020 Apr;120:94-103
pubmed: 31866469
Thromb Res. 2020 Jul;191:148-150
pubmed: 32381264
Crit Care. 2020 Jun 2;24(1):275
pubmed: 32487122
J Thromb Haemost. 2020 Apr;18(4):844-847
pubmed: 32073213
J Thromb Haemost. 2020 Sep;18(9):2349-2357
pubmed: 32692862
Circ Res. 2020 Jul 31;127(4):571-587
pubmed: 32586214
J Thromb Haemost. 2020 Oct;18(10):2629-2635
pubmed: 32692874
JAMA. 2020 Aug 25;324(8):799-801
pubmed: 32702090
Intern Emerg Med. 2020 Aug;15(5):865-870
pubmed: 32592114
Circulation. 2020 Jul 14;142(2):114-128
pubmed: 32421381
J Am Coll Cardiol. 2020 Jul 28;76(4):480-482
pubmed: 32479784
Thromb Res. 2020 Nov;195:95-99
pubmed: 32682004
Intensive Care Med. 2020 Jun;46(6):1089-1098
pubmed: 32367170
Thromb Res. 2020 Jul;191:76-77
pubmed: 32402996
Res Pract Thromb Haemost. 2020 Jun 30;4(5):842-847
pubmed: 32685893
Thromb Res. 2020 Jul;191:9-14
pubmed: 32353746
Chirurg. 2020 Jul;91(7):588-594
pubmed: 32504106
Heart Lung Vessel. 2013;5(4):219-25
pubmed: 24364016
J Clin Med. 2020 Jun 08;9(6):
pubmed: 32521707
Semin Thromb Hemost. 2015 Feb;41(1):68-74
pubmed: 25594495
JAMA Netw Open. 2020 May 1;3(5):e2010478
pubmed: 32469410
Chest. 2020 Nov;158(5):2130-2135
pubmed: 32710891
Thromb Haemost. 2020 Aug;120(8):1230-1232
pubmed: 32349132
JAMA. 2000 Apr 19;283(15):2008-12
pubmed: 10789670
J Thromb Haemost. 2020 Aug;18(8):1995-2002
pubmed: 32369666
J Thromb Haemost. 2020 Sep;18(9):2358-2363
pubmed: 32633068
Intensive Care Med. 2020 Jun;46(6):1121-1123
pubmed: 32322918
Chest. 2020 Sep;158(3):1143-1163
pubmed: 32502594
J Am Coll Surg. 2020 Aug;231(2):193-203.e1
pubmed: 32422349
Clin Med (Lond). 2020 Jul;20(4):e76-e81
pubmed: 32423903
Thromb Res. 2020 Jul;191:145-147
pubmed: 32291094
J Am Coll Cardiol. 2020 Jun 16;75(23):2950-2973
pubmed: 32311448
J Thromb Thrombolysis. 2021 Jan;51(1):33-39
pubmed: 32607652
Crit Care. 2020 Jun 2;24(1):274
pubmed: 32487231
Nat Med. 2020 Jul;26(7):1017-1032
pubmed: 32651579
Arterioscler Thromb Vasc Biol. 2020 Sep;40(9):2332-2337
pubmed: 32628040
Thromb Res. 2020 Dec;196:382-394
pubmed: 32992075
Crit Care Med. 2020 Sep;48(9):e783-e790
pubmed: 32459672
Br J Haematol. 2020 Aug;190(3):e134-e137
pubmed: 32484907
Vasc Med. 2020 Oct;25(5):471-478
pubmed: 32558620
Circulation. 2020 Jul 14;142(2):184-186
pubmed: 32330083
Int J Lab Hematol. 2020 Jun;42 Suppl 1:19-20
pubmed: 32311843
Thromb Res. 2020 Dec;196:359-366
pubmed: 32977137
Blood. 2020 Jul 23;136(4):489-500
pubmed: 32492712
J Vasc Surg Venous Lymphat Disord. 2021 Jan;9(1):36-46
pubmed: 32593770
BMJ. 2003 Sep 6;327(7414):557-60
pubmed: 12958120