Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis

BackgroundThe prevalence of venous thromboembolic event (VTE) and arterial thromboembolic event (ATE) thromboembolic events in patients with COVID-19 remains largely unknown.MethodsIn this meta-analysis, we systematically searched for observational studies describing the prevalence of VTE and ATE in COVID-19 up to 30 September 2020.ResultsWe analysed findings from 102 studies (64 503 patients). The frequency of COVID-19-related VTE was 14.7% (95% CI 12.1% to 17.6%, I2=94%; 56 studies; 16 507 patients). The overall prevalence rates of pulmonary embolism (PE) and leg deep vein thrombosis were 7.8% (95% CI 6.2% to 9.4%, I2=94%; 66 studies; 23 117 patients) and 11.2% (95% CI 8.4% to 14.3%, I2=95%; 48 studies; 13 824 patients), respectively. Few were isolated subsegmental PE. The VTE prevalence was significantly higher in intensive care unit (ICU) (23.2%, 95% CI 17.5% to 29.6%, I2=92%, vs 9.0%, 95% CI 6.9% to 11.4%, I2=95%; pinteraction<0.0001) and in series systematically screening patients compared with series testing symptomatic patients (25.2% vs 12.7%, pinteraction=0.04). The frequency rates of overall ATE, acute coronary syndrome, stroke and other ATE were 3.9% (95% CI 2.0% to to 3.0%, I2=96%; 16 studies; 7939 patients), 1.6% (95% CI 1.0% to 2.2%, I2=93%; 27 studies; 40 597 patients) and 0.9% (95% CI 0.5% to 1.5%, I2=84%; 17 studies; 20 139 patients), respectively. Metaregression and subgroup analyses failed to explain heterogeneity of overall ATE. High heterogeneity limited the value of estimates.ConclusionsPatients admitted in the ICU for severe COVID-19 had a high risk of VTE. Conversely, further studies are needed to determine the specific effects of COVID-19 on the risk of ATE or VTE in less severe forms of the disease.

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Abstract 14699: Arterial and Venous Thromboembolism in Covid-19: A Study-level Meta-analysis

Circulation ◽

10.1161/circ.142.suppl_3.14699 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Vicky Mai ◽

Kim Boun Tan ◽

Sabine Mainbourg ◽

Arnaud Frigerri ◽

Laurent Bertoletti ◽

...

Keyword(s):

Myocardial Infarction ◽

Systematic Review ◽

Observational Studies ◽

Web Of Science ◽

Meta Analysis ◽

Thromboembolic Events ◽

Vein Thrombosis ◽

Coronary Syndrome ◽

Specific Effects ◽

Deep Vein

Introduction: The prevalence of venous (VTE) and arterial (ATE) thromboembolic events in patients with COVID-19 remains largely unknown. Methods: In this systematic review and meta-analysis, we systematically searched Pubmed MEDLINE, Google Scholar, and Web of Science for observational studies describing the prevalence of VTE and ATE amongst patients with COVID-19 published between Jan 1, 2020 and May 20, 2020. The websites of major journals were also searched. Results: We analysed findings from 15 studies totalizing 1,755 patients, mainly in intensive care units (ICU). The weighted frequency of COVID-19-related VTE was 16.6% (95%CI 9.5-25.1%, I 2 =94%, 13 studies: 1,546 patients). The overall prevalence of PE and deep vein thrombosis (DVT) were 9.1% (95%CI 3.7-16.6%, I 2 =95%; 15 studies; 1,755 patients) and, 7.8% (95%CI 3.4-13.8%; I 2 =92%; 13 studies; 1,445 patients), respectively. Few were isolated subsegmental PE or distal DVT. The VTE prevalence was significantly higher in ICU (21.6%; 95%CI 12.6-32.2%; I2=91% versus 4.6%; 95%CI 1.0-10.7%, I 2 =87%, p interaction =0.002 in subgroup analysis). The weighted frequency of myocardial infarction/acute coronary syndrome, stroke, and other ATE (6 studies, 812 patients) was 3.2% (95%CI 2.1-4.5%, I 2 =0%), 0.7% (95%CI 0.0-2.2%, I 2 =64%), 2.0% (95%CI 1.2-3.0%, I 2 =40%), and 0.5% (95%CI 0.0-1.6%, I 2 =60%), respectively. Conclusions: Patients admitted in the ICU for severe COVID-19 had a high risk of VTE. Conversely, further studies are needed to determine the specific effects of COVID-19 on the risk of ATE or VTE in less severe forms of the disease.

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Incidence of thromboembolism in patients with COVID-19: a systematic review and meta-analysis

Thrombosis Journal ◽

10.1186/s12959-020-00248-5 ◽

2020 ◽

Vol 18 (1) ◽

Cited By ~ 1

Author(s):

Kochawan Boonyawat ◽

Pichika Chantrathammachart ◽

Pawin Numthavaj ◽

Nithita Nanthatanti ◽

Sithakom Phusanti ◽

...

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Meta Analysis ◽

Grey Literature ◽

Arterial Thromboembolism ◽

Vein Thrombosis ◽

Prophylactic Measures ◽

Compression Ultrasound ◽

Screening Protocol ◽

Deep Vein

Abstract Background Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, the incidence of thromboembolism has been increasingly reported. The aim of this systematic review was to explore the incidence of venous and arterial thromboembolism among COVID-19 patients requiring hospitalization. Methods Medline, Embase, Scopus, and grey literature were searched until June 2020. Observational studies reported on the incidence of venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT) or arterial thromboembolism (ATE) were included. The pool incidences and their 95% confidence intervals (CI) were calculated using the random-effects model. Results A total of 36 studies were included. In the intensive care unit (ICU) setting, the pooled incidence of VTE was 28% (95% CI, 22–34%). Subgroups based on compression ultrasound (CUS) screening revealed a higher incidence of DVT in the CUS screening group than in the no CUS screening group (32% [95% CI, 18–45%] vs. 6% [95% CI, 4–9%]). The pooled incidence of ATE in ICU was 3% (95% CI, 2–5%). In the non-ICU setting, the pooled incidence of VTE was 10% (95% CI, 6–14%,). Conclusions The incidence of VTE in COVID-19 patients was higher in the ICU setting than in the non-ICU setting, and also significantly higher in studies that incorporated the CUS screening protocol. The incidence of ATE in the ICU setting was low. VTE prophylactic measures should be given to all hospitalized patients diagnosed with COVID-19.

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Treatment of Superficial Vein Thrombosis: A Systematic Review and Meta-Analysis

Thrombosis and Haemostasis ◽

10.1055/s-0039-1677793 ◽

2019 ◽

Vol 119 (03) ◽

pp. 479-489 ◽

Cited By ~ 3

Author(s):

Lisa Duffett ◽

Clive Kearon ◽

Marc Rodger ◽

Marc Carrier

Keyword(s):

Systematic Review ◽

Primary Outcome ◽

Event Rate ◽

Meta Analysis ◽

Vein Thrombosis ◽

Superficial Vein Thrombosis ◽

Venous Thromboembolic ◽

Event Rates ◽

Deep Vein

Background The optimal first line treatment for patients with isolated superficial venous thrombosis (SVT) of the lower extremity is unknown. Objective This article reports estimates of the rate of venous thromboembolic complications among patients with SVT according to treatment. Materials and Methods A systematic review and meta-analysis was performed using unrestricted searches of electronic databases. Reported events were transformed to event per 100 patient-years of follow-up and a random effects model was used to calculate pooled rates according to pre-specified treatment categories. The primary outcome was the occurrence of deep vein thrombosis (DVT) or pulmonary embolism (PE) during the study follow-up period. Results Seventeen articles, including 6,862 patients, were included in the meta-analysis. Fondaparinux had the lowest event rate with 1.4 events per 100 patient-years of follow-up (95% confidence interval [CI], 0.5–2.8, I 2 = 18%). Pooled event rates for DVT or PE ranged from 9.3 to 16.6 events per 100 patient-years across other treatment categories, and the pooled event rate for no treatment/placebo was 10.5 events per 100 patient-years (95% CI, 3.0–22.0). Major bleeding was low and similar across all treatment categories. Heterogeneity was moderate to high for most pooled estimates. Conclusion While pooled event rates suggest that fondaparinux achieves the lowest rate of DVT or PE, low-quality evidence for other treatments prevents firm conclusions about the optimal treatment for SVT.

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Incidence of thromboembolism in patients with COVID-19: a systematic review and meta-analysis

10.21203/rs.3.rs-63530/v2 ◽

2020 ◽

Author(s):

Kochawan Boonyawat ◽

Pichika Chantrathammachart ◽

Pawin Numthavej ◽

Nithita Nanthatanti ◽

Sithakom Phusanti ◽

...

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Meta Analysis ◽

Grey Literature ◽

Arterial Thromboembolism ◽

Vein Thrombosis ◽

Prophylactic Measures ◽

Compression Ultrasound ◽

Screening Protocol ◽

Deep Vein

Abstract Background: Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, the incidence of thromboembolism has been increasingly reported. The aim of this systematic review was to explore the incidence of venous and arterial thromboembolism among COVID-19 patients requiring hospitalization.Methods: Medline, Embase, Scopus, and grey literature were searched until May 2020. Observational studies reported on the incidence of venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT) or arterial thromboembolism (ATE) were included. The pool incidences and their 95% confidence intervals (CI) were calculated using the random-effects model.Results: A total of 36 studies were included. In the intensive care unit (ICU) setting, the pooled incidence of VTE was 28% (95% CI, 22-34%). Subgroups based on compression ultrasound (CUS) screening revealed a higher incidence of DVT in the CUS screening group than in the no CUS screening group (32% [95% CI, 18-45%] vs. 6% [95% CI, 4-9%]). The pooled incidence of ATE in ICU was 3% (95% CI, 2-5%). In the non-ICU setting, the pooled incidence of VTE was 10% (95% CI, 6-14%,).Conclusions:The incidence of VTE in COVID-19 patients was higher in the ICU setting than in the non-ICU setting, and also significantly higher in studies that incorporated the CUS screening protocol. The incidence of ATE in the ICU setting was low. VTE prophylactic measures should be given to all hospitalized patients diagnosed with COVID-19.

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The benefit of EXtending oral antiCOAgulation treatment (EXCOA) after acute cerebral vein thrombosis (CVT): EXCOA-CVT cluster randomized trial protocol

International Journal of Stroke ◽

10.1177/1747493018778137 ◽

2018 ◽

Vol 13 (7) ◽

pp. 771-774 ◽

Cited By ~ 11

Author(s):

Bruno Miranda ◽

Sanjith Aaron ◽

Antonio Arauz ◽

Fernando Barinagarrementeria ◽

Afshin Borhani-Haghighi ◽

...

Keyword(s):

Thromboembolic Event ◽

Cluster Randomized Trial ◽

Venous Thromboembolic Event ◽

Cerebral Vein ◽

Thromboembolic Events ◽

Cerebral Vein Thrombosis ◽

Vein Thrombosis ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Cluster Randomized

Rationale After a cerebral vein thrombosis, there is an increased risk of further venous thromboembolic events. The optimal duration of anticoagulation after cerebral vein thrombosis is unknown. Aim To compare efficacy and safety of a policy of short- (3–6 months) versus long-term (12 months) anticoagulation (any type venous thromboembolic events) after cerebral vein thrombosis for the prevention of venous thromboembolic events. Sample size estimates A sample of 1428 patients (749 per arm) allows detecting a reduction from 10 to 5% in the risk of venous thromboembolic event recurrence with 80% power at 5% significance, with 3% dropout rate. Methods and design An international multicenter, prospective cluster-randomized trial with equal allocation between both interventions (ISRCTN25644448). Each cluster is a participating center, which accepted to be randomly allocated to one of the anticoagulation policies. Eligible patients are adults with radiologically confirmed cerebral vein thrombosis within 30 days, and stable to initiate post-acute anticoagulation. Patients judged by the investigator to be an absolute indication for permanent anticoagulation are excluded. Follow-up is at 6, 12 and 24 months. Study outcomes Primary efficacy outcome is any symptomatic and confirmed fatal/nonfatal venous thromboembolic event (recurrent-cerebral vein thrombosis or non-cerebral venous thromboembolic event). Primary safety outcomes include bleeding events during treatment periods and death from any cause. Discussion This study responds to a knowledge gap in the post-acute management of cerebral vein thrombosis patients by comparing short- versus long-term anticoagulation for the prevention of venous thromboembolic event recurrence.

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NETWORK META-ANALYSIS FOR PARNAPARINE EFFECTIVENESS IN VENOUS THROMBOEMBOLIC PREVENTION IN SURGERY

Тромбоз, гемостаз и реология ◽

10.25555/thr.2018.1.0821 ◽

2018 ◽

Author(s):

К.М. Морозов ◽

А.С. Колбин ◽

Т.Л. Галанкин

Keyword(s):

Statistical Power ◽

Meta Analysis ◽

Thromboembolic Complications ◽

Short Term ◽

Vein Thrombosis ◽

Randomized Controlled ◽

Venous Thromboembolic ◽

Deep Vein ◽

Thromboembolic Prevention ◽

Therapeutic Profile

Цель исследования: сетевой мета-анализ (СМА) рандомизированных контролируемых исследований (РКИ) парнапарина, эноксапарина, надропарина и нефракционированного гепарина (НФГ) в режиме краткосрочных курсов в малых и средних дозах для профилактики венозных тромбоэмболических осложнений (ВТЭО) при хирургических и ортопедических вмешательствах у пациентов с высоким риском тромбоза глубоких вен (ТГВ). Материалы и методы. Выполнен смешанный СМА 21 РКИ парнапарина, эноксапарина, надропарина и НФГ у хирургических больных с кратковременной (1-2 недели) профилактикой ВТЭО. Результаты. По сравнению с НФГ применение парнапарина статистически значимо снижало риск развития ТГВ (на 51%) и «больших» кровотечений (на 83%). Эноксапарин и надропарин подобных преимуществ по сравнению с НФГ не продемонстрировали, что вряд ли связано с недостаточной статистической мощностью исследования. Заключение. При прочих равных условиях парнапарин может рассматриваться в качестве препарата выбора для профилактики ВТЭО в хирургии и ортопедии. Aim: network meta-analysis (NMA) of randomized controlled trials (RCTs) of parnaparin, enoxaparin, supraparin, and unfractionated heparin (UFH) in the regime of short-term courses in small and medium doses for prophylaxis of venous thromboembolic complications (VTEC) at surgical and orthopedic interventions in patients with high risk of deep vein thrombosis (DVT). Materials and methods. Mixed CMA of 21 RCTs of parnaparin, enoxaparin, supraparin and UFH was performed in surgical patients with short-term (1-2 weeks) prophylaxis of VTEС. Results. Parnaparin reduced significantly the odds of DVT (by 51%), and the odds of «large» bleedings (by 83%) compared with UFH. Both enoxaparin and nadroparin did not demonstrate convincing advantages over UFH concerning the efficacy and the safety. This fact is hardly explained due to the insufficient statistical power of the study. Conclusion. We conclude that when other things being equal, parnaparin exposes better therapeutic profile resulting parnaparin might to be considered first for VTEC prevention in surgery and orthopedics.

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Complete compression ultrasonography of the leg veins as a single test for the diagnosis of deep vein thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0037-1613436 ◽

2003 ◽

Vol 89 (02) ◽

pp. 228-234 ◽

Cited By ~ 132

Author(s):

Thomas Schwarz ◽

Kai Halbritter ◽

Jan Beyer ◽

Gabriele Siegert ◽

Wolfram Oettler ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Failure Rate ◽

Ultrasound Examination ◽

Venous Thromboembolic Event ◽

Technical Failure ◽

Vein Thrombosis ◽

Compression Ultrasound ◽

Venous Thromboembolic ◽

Deep Vein

SummaryNoninvasive diagnosis of deep vein thrombosis (DVT) is based on ultrasound examination of the leg veins, usually restricted to only compression of the proximal veins (CUS). Patients with negative CUS findings require a second examination or a combination with other tests, which impairs clinical efficiency. In this prospective outcome study, 1646 consecutive patients with clinically suspected DVT were examined once by a standardized protocol of complete compression ultrasound comprising all proximal and distal veins (CCUS) as the only diagnostic test. The examination was equivocal in 15 patients (1% technical failure rate). Another 366 patients (22%) were tested positive for proximal DVT, distal DVT, muscle vein thrombosis, or phlebitis. Of 1265 patients in whom CCUS findings were negative, 242 met exclusion criteria for follow-up (age <18, life expectancy <3 months, other reasons for anticoagulation, postthrombotic lesions of the leg veins, or lack of informed consent). During the 3 months of follow-up, three of 1023 patients with negative CCUS findings experienced a symptomatic venous thromboembolic event (0.3% [95% CI 0.1%-0.8%]). We conclude that the CCUS protocol has a low technical failure rate and is safe with respect to excluding DVT, thereby reducing the diagnostic workup of patients with suspected DVT to a single ultrasound examination.

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Prevalence of Thromboembolic Complications in COVID-19 Infection: A Systematic Review and Meta-Analysis

European Medical Journal ◽

10.33590/emj/20-00237 ◽

2021 ◽

pp. 70-80

Author(s):

Valeria Pergola ◽

Honoria Ocagli ◽

Giulia Lorenzoni ◽

Danila Azzolina ◽

Loira Leoni ◽

...

Keyword(s):

Pulmonary Embolism ◽

Thromboembolic Event ◽

Event Rate ◽

Meta Analysis ◽

Diagnostic Testing ◽

Venous Thromboembolic Event ◽

Thromboembolic Complications ◽

Analytical Estimate ◽

Venous Thromboembolic ◽

Registration Number

Introduction: The coronavirus disease (COVID-19) infection is proved to be involved in the onset of thromboembolism episodes. This study aims to evaluate the prevalence of thromboembolic complications in patients with COVID-19 from March until May 2020. Methods: A literature review was conducted in MEDLINE (via PubMed), Scopus, Embase, Cochrane, and CINHAL without any language and date of publication restriction (Prospero registration number CRD42020186925). The inclusion criteria were as following: 1) patients with diagnosis of COVID-19; 2) occurrence of thromboembolic event, and 3) patients older than 18 years of age. A multi-variable random effects model was computed accounting for correlations among outcomes by considering a heterogeneous compound symmetry covariance matrix. Results: Observational studies included 2,442 participants from 268 to 7,999 participants per study, 1,014 (41.52%) were male and 825 (33.78%) were female. The multi-variable pooled event rate of acute myocardial infarction was rare, estimated to be 0.03 (95% confidence interval [CI]: 0.00–0.07; p=0.23); this is also true for the meta-analytical estimate of disseminated intravascular disease which was 0.04 (95% CI: 0.00–0.08; p=0.03). Conversely, other events were found to be more frequent. Indeed, the pooled proportion of pulmonary embolism was 0.14 (95% CI: 0.08–0.20; p<0.001), while the venous thromboembolic event rate is 0.15 (95% CI: 0.09-0.30; p=0.04). The pooled intrahospital mortality rate was equal to 0.12 (95% CI: 0.08–0.16; p<0.001). Conclusions: Thromboembolic events, particularly venous thromboembolic event rate and pulmonary embolism, are a frequent complication in patients hospitalised with COVID-19. These findings suggest that the threshold for clinical suspicion should be low to trigger prompt diagnostic testing and that evaluation of therapeutic treatment should be considered in patients in intensive care units with COVID-19.

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Incidence of thromboembolism in patients with COVID-19: a systematic review and meta-analysis

10.21203/rs.3.rs-63530/v1 ◽

2020 ◽

Author(s):

Kochawan Boonyawat ◽

Pichika Chantrathammachart ◽

Pawin Numthavej ◽

Nithita Nanthatanti ◽

Sithakom Phusanti ◽

...

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Meta Analysis ◽

Grey Literature ◽

Arterial Thromboembolism ◽

Vein Thrombosis ◽

Prophylactic Measures ◽

Compression Ultrasound ◽

Screening Protocol ◽

Deep Vein

Abstract Background Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, the incidence of thromboembolism has been increasingly reported. The aim of this systematic review was to explore the incidence of venous and arterial thromboembolism among COVID-19 patients requiring hospitalization. Methods Medline, Embase, Scopus, and grey literature were searched until May 2020. Observational studies reported on the incidence of venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT) or arterial thromboembolism (ATE) were included. The pool incidences and their 95% confidence intervals (CI) were calculated using the random-effects model. Results A total of 26 studies were included. In the intensive care unit (ICU) setting, the pooled incidence of VTE was 27% (95% CI, 20–35%). Subgroups based on compression ultrasound (CUS) screening revealed a higher incidence of DVT in the CUS screening group than in the no CUS screening group (27% [95% CI, 20–35%] vs. 3% [95% CI, 1–5%]). The pooled incidence of ATE in ICU was 3% (95% CI, 2–4%). In the non-ICU setting, the pooled incidence of VTE was 8% (95% CI, 4–12%,). Conclusions The incidence of VTE in COVID-19 patients was higher in the ICU setting than in the non-ICU setting, and also significantly higher in studies that incorporated the CUS screening protocol. The incidence of ATE in the ICU setting was low. VTE prophylactic measures should be given to all hospitalized patients diagnosed with COVID-19, especially in the ICU setting.

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Anticancer drugs associated with venous thromboembolic event: Analysis of the WHO pharmacovigilance database.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.3094 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 3094-3094

Author(s):

Angélique DA Silva ◽

Joachim Alexandre ◽

Damien Laneelle ◽

Marion Sassier ◽

Basile Chrétien ◽

...

Keyword(s):

Thromboembolic Event ◽

Venous Thromboembolic Event ◽

Population Characteristics ◽

Event Analysis ◽

Primary Tumor Site ◽

New Therapies ◽

Vein Thrombosis ◽

Venous Thromboembolic ◽

Registration Number ◽

Pharmacovigilance Database

3094 Background: Venous thromboembolic event (VTE) is a frequent complication of cancer, as of some classical cancer therapy, like chemotherapy and surgery. The advent of new therapies such as immunotherapy and targeted therapies has meant that new therapies may be associated with VTE. Reliable data concerning the association between ADs and VTE are scarce. Methods: On March 1st, 2020 we utilized VigiBase (International pharmacovigilance database) and performed a disproportionality analysis using reporting odds ratios (ROR) to determine the association between the 206 FDA- or EMA-labeled ADs and VTE, defined as deep vein thrombosis and pulmonary embolism. RORs were adjusted (aRORs) on population characteristics including the cancer risk of VTE with the primary tumor site according to Khorana classification and metastatic status. Results: A total of 50,438 VTE cases associated with at least one AD were identified. Thirteen ADs were associated with higher reporting of VTE of which 2 represented new VTE associations not previously confirmed in the summary of product characteristics or literature including sipuleucel-t and megestrol. ADs more reported with VTE were lenalidomide (n:5,796), bevacizumab (n:2,780) and thalidomide (n:1,700). ADs associated-VTE occurred mainly during the first 6 months after AD initiation. Conclusions: Although cancer itself may generate VTE, we identified 13 ADs associated with VTE overreporting. Recognition of AD most likely to cause VTE can help raise practitioner awareness and lead to earlier diagnosis and treatment. Futures studies should include ADs in VTE risk evaluation and evaluate the management of VTE when recurrences occur under AD favoring VTE. ClinicalTrial registration number: NCT04696250.

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