Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis.
Arterial thromboembolism
Covid-19
Deep vein thrombosis
Pulmonary embolism
Venous thromboembolism
Journal
EClinicalMedicine
ISSN: 2589-5370
Titre abrégé: EClinicalMedicine
Pays: England
ID NLM: 101733727
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
18
08
2020
revised:
31
10
2020
accepted:
02
11
2020
entrez:
30
11
2020
pubmed:
1
12
2020
medline:
1
12
2020
Statut:
ppublish
Résumé
Studies have suggested that there is increased risk of thromboembolism (TE) associated with coronavirus disease 2019 (COVID-19). However, overall arterial and venous TE rates of COVID-19 and effect of TE on COVID-19 mortality is unknown. We did a systematic review and meta-analysis of studies evaluating TE in COVID-19. We searched PubMed, Cochrane, and Embase for studies published up to June 12, 2020. Random effects models were used to produce summary TE rates and odds ratios (OR) of mortality in COVID-19 patients with TE compared to those without TE. Heterogeneity was quantified with Of 425 studies identified, 42 studies enrolling 8271 patients were included in the meta-analysis. Overall venous TE rate was 21% (95% CI:17-26%): ICU, 31% (95% CI: 23-39%). Overall deep vein thrombosis rate was 20% (95% CI: 13-28%): ICU, 28% (95% CI: 16-41%); postmortem, 35% (95% CI:15-57%). Overall pulmonary embolism rate was 13% (95% CI: 11-16%): ICU, 19% (95% CI:14-25%); postmortem, 22% (95% CI:16-28%). Overall arterial TE rate was 2% (95% CI: 1-4%): ICU, 5% (95%CI: 3-7%). Pooled mortality rate among patients with TE was 23% (95%CI:14-32%) and 13% (95% CI:6-22%) among patients without TE. The pooled odds of mortality were 74% higher among patients who developed TE compared to those who did not (OR, 1.74; 95%CI, 1.01-2.98; TE rates of COVID-19 are high and associated with higher risk of death. Robust evidence from ongoing clinical trials is needed to determine the impact of thromboprophylaxis on TE and mortality risk of COVID-19. None.
Sections du résumé
BACKGROUND
BACKGROUND
Studies have suggested that there is increased risk of thromboembolism (TE) associated with coronavirus disease 2019 (COVID-19). However, overall arterial and venous TE rates of COVID-19 and effect of TE on COVID-19 mortality is unknown.
METHODS
METHODS
We did a systematic review and meta-analysis of studies evaluating TE in COVID-19. We searched PubMed, Cochrane, and Embase for studies published up to June 12, 2020. Random effects models were used to produce summary TE rates and odds ratios (OR) of mortality in COVID-19 patients with TE compared to those without TE. Heterogeneity was quantified with
FINDINGS
RESULTS
Of 425 studies identified, 42 studies enrolling 8271 patients were included in the meta-analysis. Overall venous TE rate was 21% (95% CI:17-26%): ICU, 31% (95% CI: 23-39%). Overall deep vein thrombosis rate was 20% (95% CI: 13-28%): ICU, 28% (95% CI: 16-41%); postmortem, 35% (95% CI:15-57%). Overall pulmonary embolism rate was 13% (95% CI: 11-16%): ICU, 19% (95% CI:14-25%); postmortem, 22% (95% CI:16-28%). Overall arterial TE rate was 2% (95% CI: 1-4%): ICU, 5% (95%CI: 3-7%). Pooled mortality rate among patients with TE was 23% (95%CI:14-32%) and 13% (95% CI:6-22%) among patients without TE. The pooled odds of mortality were 74% higher among patients who developed TE compared to those who did not (OR, 1.74; 95%CI, 1.01-2.98;
INTERPRETATION
CONCLUSIONS
TE rates of COVID-19 are high and associated with higher risk of death. Robust evidence from ongoing clinical trials is needed to determine the impact of thromboprophylaxis on TE and mortality risk of COVID-19.
FUNDING
BACKGROUND
None.
Identifiants
pubmed: 33251499
doi: 10.1016/j.eclinm.2020.100639
pii: S2589-5370(20)30383-7
pmc: PMC7679115
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100639Informations de copyright
© 2020 The Authors.
Références
Ann Intern Med. 2009 Aug 18;151(4):264-9, W64
pubmed: 19622511
Swiss Med Wkly. 2020 Apr 11;150:w20247
pubmed: 32277760
Clin Chim Acta. 2020 Aug;507:167-173
pubmed: 32348783
Thromb Res. 2020 Sep;193:1-4
pubmed: 32485437
Arch Intern Med. 2004 May 10;164(9):963-8
pubmed: 15136304
Ann Intern Med. 2020 Aug 18;173(4):268-277
pubmed: 32374815
Intensive Care Med. 2020 Jun;46(6):1089-1098
pubmed: 32367170
Radiology. 2020 Sep;296(3):E189-E191
pubmed: 32324102
EClinicalMedicine. 2020 Jun 25;24:100434
pubmed: 32766543
J Thromb Haemost. 2020 May;18(5):1094-1099
pubmed: 32220112
J Thromb Thrombolysis. 2020 Aug;50(2):302-304
pubmed: 32504449
Eur Respir J. 2020 Jul 30;56(1):
pubmed: 32398294
Control Clin Trials. 1986 Sep;7(3):177-88
pubmed: 3802833
Thromb Res. 2020 Aug;192:23-26
pubmed: 32405101
Int J Cardiol. 2020 Aug 15;313:129-131
pubmed: 32471650
Circulation. 2020 Jul 14;142(2):181-183
pubmed: 32412320
Thromb Res. 2020 Aug;192:113-115
pubmed: 32425261
TH Open. 2020 Jun 08;4(2):e113-e115
pubmed: 32529170
Lancet. 2020 Mar 28;395(10229):1054-1062
pubmed: 32171076
J Thromb Haemost. 2020 Jun;18(6):1421-1424
pubmed: 32271988
J Thromb Haemost. 2020 Jul;18(7):1743-1746
pubmed: 32320517
Int J Legal Med. 2020 Jul;134(4):1275-1284
pubmed: 32500199
J Thromb Thrombolysis. 2020 Jul;50(1):211-216
pubmed: 32451823
Eur Radiol. 2020 Nov;30(11):6170-6177
pubmed: 32518989
Thromb Res. 2020 Jul;191:148-150
pubmed: 32381264
Crit Care. 2020 Jun 2;24(1):275
pubmed: 32487122
Ann Intern Med. 2020 Sep 1;173(5):350-361
pubmed: 32422076
J Thromb Haemost. 2020 Apr;18(4):844-847
pubmed: 32073213
Histopathology. 2020 Aug;77(2):198-209
pubmed: 32364264
J Thromb Thrombolysis. 2020 Aug;50(2):281-286
pubmed: 32394236
Radiology. 2020 Sep;296(3):E186-E188
pubmed: 32324103
Eur J Heart Fail. 2020 Jun;22(6):1046-1047
pubmed: 32463538
J Thromb Haemost. 2020 May;18(5):1023-1026
pubmed: 32338827
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 Jul;191:76-77
pubmed: 32402996
Res Pract Thromb Haemost. 2020 Jun 30;4(5):842-847
pubmed: 32685893
Respirology. 2015 Jul;20(5):799-804
pubmed: 25728265
Thromb Res. 2020 Jul;191:9-14
pubmed: 32353746
Chirurg. 2020 Jul;91(7):588-594
pubmed: 32504106
JAMA Netw Open. 2020 May 1;3(5):e2010478
pubmed: 32469410
BMJ Evid Based Med. 2018 Apr;23(2):60-63
pubmed: 29420178
J Thromb Haemost. 2020 Aug;18(8):1995-2002
pubmed: 32369666
Eur Respir J. 2020 Jul 30;56(1):
pubmed: 32398297
J Thromb Thrombolysis. 2020 Oct;50(3):543-547
pubmed: 32519165
Lancet. 2020 Feb 15;395(10223):497-506
pubmed: 31986264
Chest. 2020 Sep;158(3):1143-1163
pubmed: 32502594
J Vasc Surg Venous Lymphat Disord. 2019 May;7(3):317-324
pubmed: 30477976
Acta Anaesthesiol Scand. 2019 May;63(5):630-638
pubmed: 30623406
Tunis Med. 2020 Apr;98(4):261-265
pubmed: 32395788
Clin Med (Lond). 2020 Jul;20(4):e76-e81
pubmed: 32423903
Radiology. 2020 Dec;297(3):E335-E338
pubmed: 32407256
J Am Coll Cardiol. 2020 Jun 16;75(23):2950-2973
pubmed: 32311448
Crit Care. 2020 Jun 2;24(1):274
pubmed: 32487231
Crit Care Med. 2020 Sep;48(9):e783-e790
pubmed: 32459672
Br J Haematol. 2020 Aug;190(3):e134-e137
pubmed: 32484907
Circulation. 2020 Jul 14;142(2):184-186
pubmed: 32330083
Rev Esp Cardiol (Engl Ed). 2020 Sep;73(9):769-771
pubmed: 32499015
Crit Care. 2020 Apr 28;24(1):174
pubmed: 32345353
BMC Med Res Methodol. 2017 Jul 17;17(1):107
pubmed: 28716005
Blood. 2020 Jul 23;136(4):489-500
pubmed: 32492712