Venous Thromboembolism in Hospitalized COVID-19 Patients: Systematic Review

Abstract

BACKGROUND Coagulopathy associated with COVID-19 infection and venous thromboembolism (VTE) have emerged as significant contributors to morbidity in the Covid-19 pandemic. OBJECTIVE We performed a systematic review to estimate VTE incidence in hospitalized patients and to analyze characteristic factors in the VTE cohort. METHODS We searched PubMed and Google Scholar using specified title search terms "SARS-Cov-2" or "COVID-19" and "Venous Thromboembolism" and "anticoagulation" among others to identify peer reviewed journal articles published from 6/22/2019 to 6/22/2020. Data was systematically extracted and synthesized using Microsoft Excel for analysis. The main outcome was VTE incidence and measures included patient characteristics, anticoagulation, and clinical outcomes with assessment for associations. RESULTS 14 studies were included with 1677 patients. 83.3% of patients received anticoagulation, either VTE prophylaxis or treatment. VTE incidence was 26.9% (SE 3.1; 95% CI 20.8-33.1) and was correlated with systematic screening (r2 0.34, p = 0.03) and study duration (r2 -0.33, p = 0.03). D-dimer was higher for the VTE cohort (5.62 ± 0.9 vs. 1.43 ± 0.6, p = 0.00006). Odds of VTE were higher with ICU level of care (OR 6.38; 95% CI 3.67 to 11.11; p = 0.0000) but lower with anticoagulation (OR 0.58; 95% CI 0.36 to 0.92, p = 0.02). CONCLUSIONS Despite utilization of background anticoagulation, VTE incidence was historically high. Future studies will provide additional data to guide optimal VTE prophylaxis and diagnostic strategies. CLINICALTRIAL