Venous thromboembolism in critically ill COVID-19 patients receiving prophylactic or therapeutic anticoagulation: a systematic review and meta-analysis

Abstract Many aspects of care such as management of hypercoagulable state in COVID-19 patients, especially those admitted to intensive care units is challenging in the rapidly evolving pandemic of novel coronavirus disease 2019 (COVID-19). We seek to systematically review the available evidence regarding the anticoagulation approach to prevent venous thromboembolism (VTE) among COVID-19 patients admitted to intensive care units. Electronic databases were searched for studies reporting venous thromboembolic events in patients admitted to the intensive care unit receiving any type of anticoagulation (prophylactic or therapeutic). The pooled prevalence (and 95% confidence interval [CI]) of VTE among patients receiving anticoagulant were calculated using the random-effects model. Subgroup pooled analyses were performed with studies reported prophylactic anticoagulation alone and with studies reported mixed prophylactic and therapeutic anticoagulation. We included twelve studies (8 Europe; 2 UK; 1 each from the US and China) in our systematic review and meta-analysis. All studies utilized LMWH or unfractionated heparin as their pharmacologic thromboprophylaxis, either prophylactic doses or therapeutic doses. Seven studies reported on the proportion of patients with the previous history of VTE (range 0–10%). The pooled prevalence of VTE among ICU patients receiving prophylactic or therapeutic anticoagulation across all studies was 31% (95% CI 20–43%). Subgroup pooled analysis limited to studies reported prophylactic anticoagulation alone and mixed (therapeutic and prophylactic anticoagulation) reported pooled prevalences of VTE of 38% (95% CI 10–70%) and 27% (95% CI 17–40%) respectively. With a high prevalence of thromboprophylaxis failure among COVID-19 patients admitted to intensive care units, individualised rather than protocolised VTE thromboprophylaxis would appear prudent at interim.

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Prevalence of Venous Thromboembolism in Critically-ill COVID-19 Patients: Systematic Review and Meta-analysis

10.1101/2020.08.24.20175745 ◽

2020 ◽

Author(s):

Mouhand F.H. Mohamed ◽

Shaikha D. Al-Shokri ◽

Khaled M. Shunnar ◽

Sara F. Mohamed ◽

Mostafa S. Najim ◽

...

Keyword(s):

Systematic Review ◽

Venous Thromboembolism ◽

Critically Ill ◽

Meta Analysis ◽

Ongoing Debate ◽

Systematic Screening ◽

Randomized Controlled ◽

Therapeutic Anticoagulation ◽

High Prevalence ◽

Prophylactic Anticoagulation

Background: Recent studies revealed a high prevalence of venous thromboembolism (VTE) events in coronavirus disease 2019 (COVID-19) patients, especially in those who are critically ill. Available studies report varying prevalence rates. Hence, the exact prevalence remains uncertain. Moreover, there is an ongoing debate regarding the appropriate dosage of thromboprophylaxis. Methods: We performed a systematic review and proportion meta-analysis following PRISMA guidelines. We searched PubMed and EMBASE for studies exploring the prevalence of VTE in critically ill COVID-19 patients till 22/07/2020. We pooled the proportion of VTE. Additionally, in a subgroup analysis, we pooled VTE events detected by systematic screening. Finally, we compared the odds of VTE in patients on prophylactic compared to therapeutic anticoagulation. Results: The review comprised of 24 studies and over 2500 patients. The pooled proportion of VTE prevalence was 0.31 (95% CI 0.24, 0.39 I2 94%), of VTE utilizing systematic screening was 0.48 (95% CI 0.33, 0.63 I2 91%), of deep-venous-thrombosis was 0.23 (95% CI 0.14, 0.32 I2 96%), of pulmonary embolism was 0.14 (95% CI 0.09, 0.20 I2 90%). In a subgroup of studies, utilizing systematic screening, VTE risk increased significantly with prophylactic, compared to therapeutic anticoagulation (OR 5.45; 95% CI 1.90, 15.57 I2 0%). Discussion: Our review revealed a high prevalence of VTE in critically ill COVID-19 patients. Almost 50% of patients had VTE detected by systematic screening. Higher thromboprophylaxis dosages seem to reduce VTE burden in this patient's cohort compared to standard prophylactic anticoagulation; ongoing randomized controlled trials will further confirm this.

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Prevalence of Venous Thromboembolism in Critically Ill COVID-19 Patients: Systematic Review and Meta-Analysis

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2020.598846 ◽

2021 ◽

Vol 7 ◽

Author(s):

Mouhand F. H. Mohamed ◽

Shaikha D. Al-Shokri ◽

Khaled M. Shunnar ◽

Sara F. Mohamed ◽

Mostafa S. Najim ◽

...

Keyword(s):

Systematic Review ◽

Venous Thromboembolism ◽

Critically Ill ◽

Meta Analysis ◽

Exploratory Analysis ◽

Systematic Screening ◽

Therapeutic Anticoagulation ◽

High Prevalence ◽

Meta Analyses ◽

Prophylactic Anticoagulation

Background: Recent studies revealed a high prevalence of venous thromboembolism (VTE) events in coronavirus disease 2019 (COVID-19) patients, especially in those who are critically ill. Available studies report varying prevalence rates. Hence, the exact prevalence remains uncertain. Moreover, there is an ongoing debate regarding the appropriate dosage of thromboprophylaxis.Methods: We performed a systematic review and proportion meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed and EMBASE for studies exploring the prevalence of VTE in critically ill COVID-19 patients till 25/07/2020. We pooled the proportion of VTE. Additionally, in a subgroup analysis, we pooled VTE events detected by systematic screening. Finally, in an exploratory analysis, we compared the odds of VTE in patients on prophylactic compared with therapeutic anticoagulation.Results: The review comprised 24 studies and over 2,500 patients. The pooled proportion of VTE prevalence was 0.31 [95% confidence interval (CI) 0.24, 0.39; I2 94%], of VTE utilizing systematic screening was 0.48 (95% CI 0.33, 0.63; I2 91%), of deep venous thrombosis was 0.23 (95% CI 0.14, 0.32; I2 96%), and of pulmonary embolism was 0.14 (95% CI 0.09, 0.20; I2 90%). Exploratory analysis of few studies, utilizing systematic screening, VTE risk increased significantly with prophylactic, compared with therapeutic anticoagulation [odds ratio (OR) 5.45; 95% CI 1.90, 15.57; I2 0%].Discussion: Our review revealed a high prevalence of VTE in critically ill COVID-19 patients. Almost 50% of patients had VTE detected by systematic screening. Higher thromboprophylaxis dosages may reduce VTE burden in this patient's cohort compared with standard prophylactic anticoagulation; however, this is to be ascertained by ongoing randomized controlled trials.

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Risk of intracranial hemorrhage associated with therapeutic anticoagulation for venous thromboembolism in cancer patients: a systematic review and meta-analysis

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-016-1434-4 ◽

2016 ◽

Vol 43 (2) ◽

pp. 233-240 ◽

Cited By ~ 6

Author(s):

Cristhiam M. Rojas-Hernandez ◽

Thein Hlaing Oo ◽

Herney Andrés García-Perdomo

Keyword(s):

Systematic Review ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Intracranial Hemorrhage ◽

Meta Analysis ◽

Therapeutic Anticoagulation

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Sepsis prediction during outbreaks at neonatal intensive care units through body surface screening for Gram-negative bacteria: systematic review and meta-analysis

BMC Research Notes ◽

10.1186/s13104-018-4033-y ◽

2018 ◽

Vol 11 (1) ◽

Cited By ~ 1

Author(s):

Thomas Harder ◽

Sebastian Haller ◽

Tim Eckmanns ◽

Juliane Seidel

Keyword(s):

Systematic Review ◽

Intensive Care ◽

Intensive Care Units ◽

Body Surface ◽

Neonatal Intensive Care ◽

Meta Analysis ◽

Neonatal Intensive Care Units ◽

Gram Negative Bacteria ◽

Gram Negative

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Handwash versus hand-rub practices for preventing nosocomial infection in hospital intensive care units: A systematic review and meta-analysis

Canadian Journal of Infection Control ◽

10.36584/cjic.2020.009 ◽

2020 ◽

pp. 82-90

Author(s):

S Bello ◽

EA Bamgboye ◽

DT Ajayi ◽

EN Ossai ◽

EC Aniwada ◽

...

Keyword(s):

Systematic Review ◽

Intensive Care ◽

Adverse Events ◽

Nosocomial Infection ◽

Intensive Care Units ◽

Meta Analysis ◽

Healthcare Providers ◽

Length Of Hospital Stay ◽

Clinical Effectiveness ◽

Infection Rates

Background: Compliance with handwashing in busy healthcare facilities, such as intensive care units (ICUs), is suboptimal and alcohol hand-rub preparations have been suggested to improve compliance. There is no evidence on the comparative effectiveness between handwash and hand-rub strategies. This systematic review was to assess the effectiveness of handwash versus hand-rub strategies for preventing nosocomial infection in ICUs. Methods Studies conducted in ICUs and indexed in PubMed comparing the clinical effectiveness and adverse events between handwash and hand-rub groups were included in a systematic review. The primary outcome was nosocomial infection rates. Secondary outcomes included microbial counts on healthcare providers’ hands, mortality rates, patient/hospital cost of treatment of healthcare-associated infections (HCAIs), length of ICU/hospital stays, and adverse events. Studies were independently screened and data extracted by at least two authors. Meta-analyses of risk ratios (RR), incidence rate ratios (IRR), odds ratios (OR) and mean differences (MD), were conducted using the RevMan 5.3 software. Results: Seven studies published between 1992-2009 and involving a total of 11,663 patients were included. Five studies (10,981 patients) contributed data to the ICU acquired nosocomial infection rates. The pooled IRR was 0.71 (95% CI 0.61, 0.82; I2 = 94%). On sensitivity analysis, pooled IRR was 0.39 (95% CI 0.32, 0.48; 4 studies; 8,247 patients; I2 = 0%) in favour of hand rub. The pooled OR for mortality was 0.95 (95% CI 0.78, 1.61; 4 studies; 3,475 patients; I2 = 39%). The pooled MD for length of hospital stay was -0.74 (95% CI -2.83, 1.34; 3 studies; 741 patients; I2 = 0%). The pooled OR for an undesirable skin effect was 0.37 (95% CI 0.23, 0.60; 3 studies;1504 patients; I2 = 0%) in favour of hand rub. Overall quality of evidence was low. Conclusion: Hand rub appeared more effective when compared to handwash in ICUs.

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Effect of dexmedetomidine on delirium during sedation in adult patients in intensive care units: A systematic review and meta-analysis

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2020.110157 ◽

2021 ◽

Vol 69 ◽

pp. 110157

Author(s):

Shuo Wang ◽

Yishun Hong ◽

Shiyong Li ◽

Akira Kuriyama ◽

Yilin Zhao ◽

...

Keyword(s):

Systematic Review ◽

Intensive Care ◽

Intensive Care Units ◽

Meta Analysis ◽

Adult Patients

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Prevalence of focal incidental breast uptake on FDG-PET/CT and risk of malignancy: a systematic review and meta-analysis

European Journal of Hybrid Imaging ◽

10.1186/s41824-019-0063-5 ◽

2019 ◽

Vol 3 (1) ◽

Author(s):

Else Marie Aarstad ◽

Petter Nordhaug ◽

Mohammad Naghavi-Behzad ◽

Lisbet Brønsro Larsen ◽

Oke Gerke ◽

...

Keyword(s):

Systematic Review ◽

Fdg Pet ◽

Fixed Effects ◽

Meta Analysis ◽

Previous History ◽

Fdg Uptake ◽

Pooled Prevalence ◽

Pet Ct ◽

Risk Of Malignancy ◽

Fdg Pet Ct

Abstract Background FDG-PET/CT is increasingly used for oncologic and inflammatory diseases. Focal incidental FDG uptake occurs rarely in breast tissue but has often significant consequences. This study aimed to systematically review literature regarding focal incidental breast uptake (FIBU) on FDG-PET/CT in order to yield an update on the prevalence and risk of malignancy for FIBU. Methods A systematic search for relevant articles published between 2012 and 2018 was performed through MEDLINE, Embase, and Cochrane databases. Studies addressing the detection of FIBU in patients without a previous history of breast malignancy were included. The QUADAS-2 was used for quality assessment, and eligible data were pooled using a fixed-effects model. I2 was calculated for the heterogeneity between studies. Results Eight studies containing 180,002 scans were included in the systematic review. The median prevalence of FIBU for both genders was 0.52% (range 0.18–22.5%). Prevalence for women was mentioned separately in five studies and varied from 0.51 to 23.5%. One study reporting a high prevalence was based on patients being staged for known malignancy, and the word “breast” was used in the search, which may have caused selection bias. Data from four studies were eligible for meta-analysis. A high degree of heterogeneity was observed for prevalence data (I2 of 97.5%), while moderate heterogeneity was observed for data on malignancy risk assessment (I2 of 62.8%). The pooled prevalence of FIBU in women was 0.61% (range 0.56–0.66%), and the pooled prevalence of malignancy of FIBUs was 38.7% (range 34.4–43.0%). The most commonly detected malignancy was invasive ductal carcinoma. Conclusion FIBU occurs rarely on FDG-PET/CT for female patients but yields a high risk of malignancy according to the results of published papers. Therefore, it should be considered relevant to further elucidate patients with incidentally detected FDG uptake in breast in clinical practice.

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