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Thrombosis Journal

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Open Access 01-12-2021 | Phlebothrombosis | Research

Proximal deep vein thrombosis and pulmonary embolism in COVID-19 patients: a systematic review and meta-analysis

Authors: Gregoire Longchamp, Sara Manzocchi-Besson, Alban Longchamp, Marc Righini, Helia Robert-Ebadi, Marc Blondon

Published in: Thrombosis Journal | Issue 1/2021

Abstract

Background

COVID-19 appears to be associated with a high risk of venous thromboembolism (VTE). We aimed to systematically review and meta-analyze the risk of clinically relevant VTE in patients hospitalized for COVID-19.

Methods

This meta-analysis included original articles in English published from January 1st, 2020 to June 15th, 2020 in Pubmed/MEDLINE, Embase, Web of science, and Cochrane. Outcomes were major VTE, defined as any objectively diagnosed pulmonary embolism (PE) and/or proximal deep vein thrombosis (DVT). Primary analysis estimated the risk of VTE, stratified by acutely and critically ill inpatients. Secondary analyses explored the separate risk of proximal DVT and of PE; the risk of major VTE stratified by screening and by type of anticoagulation.

Results

In 33 studies (n = 4009 inpatients) with heterogeneous thrombotic risk factors, VTE incidence was 9% (95%CI 5–13%, I² = 92.5) overall, and 21% (95%CI 14–28%, I² = 87.6%) for patients hospitalized in the ICU. Proximal lower limb DVT incidence was 3% (95%CI 1–5%, I² = 87.0%) and 8% (95%CI 3–14%, I² = 87.6%), respectively. PE incidence was 8% (95%CI 4–13%, I² = 92.1%) and 17% (95%CI 11–25%, I² = 89.3%), respectively. Screening and absence of anticoagulation were associated with a higher VTE incidence. When restricting to medically ill inpatients, the VTE incidence was 2% (95%CI 0–6%).

Conclusions

The risk of major VTE among COVID-19 inpatients is high but varies greatly with severity of the disease. These findings reinforce the need for the use of thromboprophylaxis in all COVID-19 inpatients and for clinical trials testing different thromboprophylaxis regimens in subgroups of COVID-19 inpatients.

Trial registration

The review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews (CRD42020193369).

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Title: Proximal deep vein thrombosis and pulmonary embolism in COVID-19 patients: a systematic review and meta-analysis
Authors: Gregoire Longchamp
Sara Manzocchi-Besson
Alban Longchamp
Marc Righini
Helia Robert-Ebadi
Marc Blondon
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Phlebothrombosis
COVID-19
Thrombosis
Published in: Thrombosis Journal / Issue 1/2021
Electronic ISSN: 1477-9560
DOI: https://doi.org/10.1186/s12959-021-00266-x

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Proximal deep vein thrombosis and pulmonary embolism in COVID-19 patients: a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusions

Trial registration

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Abstract

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Conclusions

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