Current best evidence for clinical care (more info)
Background: Accumulating evidence suggests that coronavirus disease 2019 (COVID-19) is associated with hypercoagulative status, particularly for critically ill patients in the intensive care unit. However, the prevalence of venous thromboembolism (VTE) in these patients under routine prophylactic anticoagulation remains unknown. A meta-analysis was performed to evaluate the prevalence of VTE in these patients by pooling the results of these observational studies. Methods: Observational studies that reported the prevalence of VTE in critically ill patients with COVID-19 were identified by searching the PubMed and Embase databases. A random-effect model was used to pool the results by incorporating the potential heterogeneity. Results: A total of 19 studies with 1,599 patients were included. The pooled results revealed that the prevalence of VTE, deep venous thrombosis (DVT), and pulmonary embolism (PE) in critically ill patients with COVID-19 was 28.4% [95% confidence interval (CI): 20.0-36.8%], 25.6% (95% CI: 17.8-33.4%), and 16.4% (95% CI: 10.1-22.7%), respectively. Limited to studies, in which all patients received routine prophylactic anticoagulation, and the prevalence for VTE, DVT, and PE was 30.1% (95% CI: 19.4-40.8%), 27.2% (95% CI: 16.5-37.9%), and 18.3% (95% CI: 9.8%-26.7%), respectively. The prevalence of DVT was higher in studies with routine screening for all patients, when compared to studies with screening only in clinically suspected patients (47.5% vs. 15.1%, P < 0.001). Conclusion: Critically ill patients with COVID-19 have a high prevalence of VTE, despite the use of present routine prophylactic anticoagulation.
| Discipline / Specialty Area | Score |
|---|---|
| Hospital Doctor/Hospitalists | |
| Internal Medicine | |
| Respirology/Pulmonology | |
| Infectious Disease | |
| Intensivist/Critical Care | |
| Hemostasis and Thrombosis | |
As a hematologist, I would expect this information.
This was a systematic review with PRISMA guidelines with variable kinds of English language studies with various range durations. The conclusion than intensive anticoagulant thromboprophylaxis should not be recommended until clinical trials that systematically evaluate the influence of such prophylaxis on the risk of VTE, bleeding, and survival in critically ill patients with COVID-19 become available, is the best part of the article.
Continued affirmation of the extraordinarily high risk of TE in patients with COVID-19, not only VTE but also ischemic stroke and acute coronary syndromes. This is so especially in those requiring care in an ICU where they are immobilized and commonly have heart failure. It underscores the critical importance of prophylactic anticoagulation of hospitalized patients with COVID-19.
This is a relatively small review of studies evaluating the risk of venous thromboembolic disease in COVID patients. The rate is relatively high compared to other studies and the sample size is small suggesting there may be some publication bias of the other studies. An important finding is that the rate is higher with routine screening.