J Vasc Surg Venous Lymphat Disord. 2021 Jan 30:S2213-333X(21)00072-X. doi: 10.1016/j.jvsv.2021.01.012. Online ahead of print.
OBJECTIVE: To summarize the incidence, anticoagulation panels, laboratory characteristics, and mortality of venous thromboembolism (VTE) in hospitalized patients with coronavirus disease 2019 (COVID-19).
METHODS: After systematically searching PubMed, Embase, the Cochrane Library, MedRxiv, and BioRxiv, a systematic review and meta-analysis of 18 retrospective, 6 prospective observational, and 2 cross-sectional studies was performed according to the guidelines of PRISMA.
RESULTS: Overall, 4382 hospitalized patients with COVID-19 were included. Males accounted for significantly more patients than did females (OR 1.59; 95%CI 1.25-2.02) (P<.001). The total incidence of VTE among COVID-19 patients was 28.3 % (95%CI 21.6-35.4), with an incidence of 38.0% (95%CI 29.1-47.4) and 17.2% (95%CI 11.4-23.8) among severe COVID-19 cases and general cases, respectively. The total incidence of deep venous thrombosis (DVT) of lower extremities was 18.3% (95%CI 10.8-27.2), and the occurrence of DVT was 22.1% (95%CI 11.0-35.5) and 12.8% (95%CI 5.0-23.3) in severe and general cases, respectively. The total incidence of pulmonary embolism (PE) was 17.6% (95%CI 12.3-23.5), with a rate of 21.7% (95%CI 14.8-29.3) in severe cases and 12.5% (95%CI 6.1-23.5) in general cases. When COVID-19 severity is unclassified, mortality in patients with VTE was not significantly higher (25.2%; 95%CI 12.2-40.5) than that in those with no VTE (10.2%; 95%CI 3.4-19.5) (odd ratios:1.88(0.46, 7.64), P= .377). However, among patients with severe COVID-19, those who had VTE had a significantly higher mortality rate than did those without VTE (OR 2.02; (95%CI 1.15-3.53), P= .014). COVID-19 patients with VTE had significantly higher D-dimer levels than did patients with no VTE in multiple studies.
CONCLUSIONS: The occurrence of VTE, DVT, and PE is substantial among hospitalized COVID-19 patients, especially severe COVID-19 patients. Severe COVID-19 patients with VTE have significantly higher mortality rate than do patients without VTE. Increased values of D-dimer may be indicators of the occurrence of VTE in COVID-19 patients.