Incidence of venous and arterial thromboembolic complications in COVID-19: A systematic review and meta-analysis.
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ABSTRACT:
SUBMITTER: Kunutsor SK
PROVIDER: S-EPMC7418701 | biostudies-literature | 2020 Dec
REPOSITORIES: biostudies-literature
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Incidence of venous and arterial thromboembolic complications in COVID-19: A systematic review and meta-analysis.
Kunutsor Setor K SK Laukkanen Jari A JA
Thrombosis research 20200811
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Project description:BackgroundCardiovascular complications, including myocardial infarction, ischemic stroke, and pulmonary embolism, represent an important source of adverse outcomes in coronavirus disease-2019 (COVID-19).ObjectivesTo assess the frequency of arterial and venous thromboembolic disease, risk factors, prevention and management patterns, and outcomes in patients with COVID-19, the authors designed a multicenter, observational cohort study.MethodsWe analyzed a retrospective cohort of 1,114 patients with COVID-19 diagnosed through our Mass General Brigham integrated health network. The total cohort was analyzed by site of care: intensive care (n = 170); hospitalized nonintensive care (n = 229); and outpatient (n = 715). The primary study outcome was a composite of adjudicated major arterial or venous thromboembolism.ResultsPatients with COVID-19 were 22.3% Hispanic/Latinx and 44.2% non-White. Cardiovascular risk factors of hypertension (35.8%), hyperlipidemia (28.6%), and diabetes (18.0%) were common. Prophylactic anticoagulation was prescribed in 89.4% of patients with COVID-19 in the intensive care cohort and 84.7% of those in the hospitalized nonintensive care setting. Frequencies of major arterial or venous thromboembolism, major cardiovascular adverse events, and symptomatic venous thromboembolism were highest in the intensive care cohort (35.3%, 45.9%, and 27.0 %, respectively) followed by the hospitalized nonintensive care cohort (2.6%, 6.1%, and 2.2%, respectively) and the outpatient cohort (0% for all).ConclusionsMajor arterial or venous thromboembolism, major adverse cardiovascular events, and symptomatic venous thromboembolism occurred with high frequency in patients with COVID-19, especially in the intensive care setting, despite a high utilization rate of thromboprophylaxis.
| S-EPMC7588178 | biostudies-literature
Project description: Not available
| S-EPMC8648604 | biostudies-literature
Project description:Data regarding the occurrence of venous thromboembolic events (VTE), including acute pulmonary embolism (PE) and deep vein thrombosis (DVT) in recovered COVID-19 patients are scant. We performed a systematic review and meta-analysis to assess the risk of acute PE and DVT in COVID-19 recovered subject. Following the PRIMSA guidelines, we searched Medline and Scopus to locate all articles published up to September 1st, 2022, reporting the risk of acute PE and/or DVT in patients recovered from COVID-19 infection compared to non-infected patients who developed VTE over the same follow-up period. PE and DVT risk were evaluated using the Mantel-Haenszel random effects models with Hazard ratio (HR) as the effect measure with 95% confidence interval (CI) while heterogeneity was assessed using Higgins I2 statistic. Overall, 29.078.950 patients (mean age 50.2 years, 63.9% males), of which 2.060.496 had COVID-19 infection, were included. Over a mean follow-up of 8.5 months, the cumulative incidence of PE and DVT in COVID-19 recovered patients were 1.2% (95% CI:0.9-1.4, I2: 99.8%) and 2.3% (95% CI:1.7-3.0, I2: 99.7%), respectively. Recovered COVID-19 patients presented a higher risk of incident PE (HR: 3.16, 95% CI: 2.63-3.79, I2 = 90.1%) and DVT (HR: 2.55, 95% CI: 2.09-3.11, I2: 92.6%) compared to non-infected patients from the general population over the same follow-up period. Meta-regression showed a higher risk of PE and DVT with age and with female gender, and lower risk with longer follow-up. Recovered COVID-19 patients have a higher risk of VTE events, which increase with aging and among females.
| S-EPMC9845812 | biostudies-literature
Project description:Introduction Venous and arterial thromboses are frequently observed complications in patients with severe novel coronavirus disease 2019 (COVID-19) infection who require hospital admission. In this study, we evaluate the epidemiology of venous and arterial thrombosis events in ambulatory and postdischarge patients with COVID-19 infection. Materials and Method EMBASE and MEDLINE were searched up to July 21, 2021, in addition to other sources. We included studies that assessed the epidemiology of venous and arterial thrombosis events in ambulatory and postdischarge COVID-19 patients. Results A total of 16 studies (102,779 patients) were identified. The overall proportion of venous thromboembolic events in all patients, that is, ambulatory and postdischarge, was 0.80% (95% confidence interval [CI]: 0.44-1.28), 0.28% (95% CI: 0.07-0.64), and 1.16% (95% CI: 0.69-1.74), respectively. Arterial events occurred in 0.75% (95% CI: 0.27-1.47) of all patients, 1.45% (95% CI: 1.10-1.86) of postdischarge patients, and 0.23% (95% CI: 0.019-0.66) of ambulatory patients. The pooled incidence rate estimates per 1,000 patient-days for VTE events were 0.06 (95% CI: 0.03-0.08) and 0.12 (95% CI: 0.07-0.19) for outpatients and postdischarge, respectively, whereas for arterial events were 0.10 (95% CI: 0-0.30) and 0.26 (95% CI: 0.16-0.37). Conclusion This study found a low risk of venous and arterial thrombi in ambulatory and postdischarge COVID-19 patients, with a higher risk in postdischarge patients compared with ambulatory patients. This suggests that regular universal thromboprophylaxis in these patient populations is probably not necessary.
| S-EPMC9484870 | biostudies-literature
Project description:Thrombolytic therapy might reduce venous thromboembolism-related mortality and morbidity, but it could also increase the risk of major bleeding. We systematically reviewed the literature to evaluate the effectiveness and safety of thrombolytics in patients with pulmonary embolism (PE) and/or deep venous thrombosis (DVT). We searched Medline, Embase, and Cochrane databases for relevant randomized controlled trials up to February 2019. Multiple investigators independently screened and collected data. We included 45 studies (4740 participants). Pooled estimates of PE studies indicate probable reduction in mortality with thrombolysis (risk ratio [RR], 0.61; 95% confidence interval [CI], 0.40-0.94) (moderate certainty) and possible reduction in nonfatal PE recurrence (RR, 0.56; 95% CI, 0.35-0.89) (low certainty). Pooled estimates of DVT studies indicate the possible absence of effects on mortality (RR, 0.77; 95% CI, 0.26-2.28) (low certainty) and recurrent DVT (RR, 0.99; 95% CI, 0.56-1.76) (low certainty), but possible reduction in postthrombotic syndrome (PTS) with thrombolytics (RR, 0.70; 95% CI, 0.59-0.83) (low certainty). Pooled estimates of the complete body of evidence indicate increases in major bleeding (RR, 1.89; 95% CI, 1.46-2.46) (high certainty) and a probable increase in intracranial bleeding (RR, 3.17; 95% CI 1.19-8.41) (moderate certainty) with thrombolytics. Our findings indicate that thrombolytics probably reduce mortality in patients with submassive- or intermediate-risk PE and may reduce PTS in patients with proximal DVT at the expense of a significant increase in major bleeding. Because the balance between benefits and harms is profoundly influenced by the baseline risks of critical outcomes, stakeholders involved in decision making would need to weigh these effects to define which clinical scenarios merit the use of thrombolytics.
| S-EPMC7160254 | biostudies-literature
Project description:BackgroundThe coronavirus (COVID-19) pandemic was reported from Wuhan, China, on December 31, 2019, and the pandemic was spread to more than 212 countries in the globe. This meta-analysis aimed to assess the pooled incidence of COVID-19 complications and to identify the association between the incidence of complications and age.MethodsComprehensive databases, PubMed, Hinari, and Google Scholar, were used to locate potential articles for this review. Data were extracted using Microsoft Excel and imported to the STATA/MP version 16.0 software for analysis. Heterogeneity between studies was assessed using the Cochrane Q test statistics and I2 test, and small study effect was checked using Egger's statistical test at 5% significant level. Sensitivity analysis was checked. A random-effects model was conducted to estimate the pooled incidence of COVID-19 complications. Univariate meta-regression was conducted to identify the association between the mean ages with each complication.ResultsFrom the total of 1237 studies, 12 studies were included with a total of 3064 COVID-19 patients. The most complications were acute respiratory distress syndrome (30.93%, 95%CI 21.3-40.6%) followed by acute liver injury (22.8%, 95%CI 14-31.5%), shock (10.9%, 95%CI 7.4-14.4%), acute kidney injury (7%, 95%CI 3.8-10.4%), and acute cardiac injury (6.4%, 95%CI 2.8-15.6%). Univariate meta-regression revealed that as the mean age increased by 1 year, the incidence of acute respiratory distress syndrome, acute kidney injury, acute cardiac injury, and shock increased by a factor of 2.9 (β = 2.9, 95%CI 2.4-3.4, adjusted R2 = 88), 0.4 (β = 0.4, 95%CI 0.04-0.72, adjusted R2 = 54), 1.6 (β = 1.6, 95%CI 1.1-2.1, adjusted R2 = 85), and 1.1 (β = 1.1, 95%CI 0.8-1.5, adjusted R2 = 26) times respectively.ConclusionSignificant complications of COVID-19 viral infections were reported. Older populations were a high-risk group of developing adverse complications as compared to their counterparts. Health care professionals should give primary attention to those risk group individuals.
| S-EPMC7980104 | biostudies-literature
Project description:Introduction The incidence of thromboembolism during COVID-19 and the use of thromboprophylaxis vary greatly between studies. Only a few studies have investigated the rate of thromboembolism post-discharge. This study determined the 90-day incidence of venous and arterial thromboembolic complications, risk factors for venous thromboembolic events and characterized the use of thromboprophylaxis during and after hospitalization. Materials and methods We retrospectively reviewed medical records for adult patients hospitalized for >24 h for COVID-19 before May 15, 2020, in ten Norwegian hospitals. We extracted data on demographics, thromboembolic complications, thromboembolic risk factors, and the use of thromboprophylaxis. Cox proportional hazards regression was used to determine risk factors for VTE. Results 550 patients were included. The 90-day incidence of arterial and venous thromboembolism in hospitalized patients was 6.9% (95% CI: 5.1–9.3) overall and 13.8% in the ICU. Male sex (hazard ratio (HR) 7.44, 95% CI 1.73–32.02, p = 0.007) and previous VTE (HR 6.11, 95% CI: 1.74–21.39, p = 0.005) were associated with risk of VTE in multivariable analysis. Thromboprophylaxis was started in 334 patients (61%) with a median duration of 7 days (25th–75th percentile 3–13); in the VTE population 10/23 (43%) started thromboprophylaxis prior to diagnosis. After discharge 20/223 patients received extended thromboprophylaxis and 2/223 (0.7%, 95% CI: 0.3–1.9) had a thromboembolism. Conclusions The 90-day incidence of thromboembolism in COVID-19 patients was 7%, but <1% after discharge. Risk factors were male sex and previous VTE. Most patients received thromboprophylaxis during hospitalization, but only <10% after discharge.
| S-EPMC8720677 | biostudies-literature
Project description:Severe coronavirus disease 2019 (COVID-19) is associated with increased risk of venous thromboembolism events (VTE). This study performed a systematic review in PubMed/EMBASE of studies reporting the prevalence of VTE in patients with COVID-19 who were totally screened/assessed for deep vein thrombosis (DVT) and/or for pulmonary embolism (PE). Among 47 candidate studies (n = 6459; 33 in Europe), 17 studies (n = 3973; weighted age 63.0 years, males 60%, intensive care unit (ICU) 16%) reported the prevalence of PE with a pooled estimate of 32% (95% CI: 25, 40%), and 32 studies (n = 2552; weighted age 62.6 years, males 57%, ICU 49%) reported the prevalence of DVT with a pooled estimate of 27% (95% CI: 21, 34%). A total of 36 studies reported the use of at least prophylactic antithrombotic treatment in the majority of their patients. Meta-regression analysis showed that the prevalence of VTE was higher across studies with a higher percentage of ICU patients and higher study population mean D-dimer values, and lower in studies with mixed dosing of anticoagulation in ⩾ 50% of the population compared to studies with standard prophylactic dosing of anticoagulation in < 50% of the population. The pooled odds ratio for death in patients with COVID-19 and VTE versus those without VTE (17 studies, n = 2882) was 2.1 (95% CI: 1.2, 3.6). Hospitalized patients with severe COVID-19 are at high VTE risk despite prophylactic anticoagulation. Further research should investigate the individualized VTE risk of patients with COVID-19 and the optimal preventive antithrombotic therapy. PROSPERO Registration No.: CRD42020185543.
| S-EPMC8024143 | biostudies-literature
Project description:PurposeEmerging data suggest that coronavirus disease 2019 (COVID-19) has extrapulmonary manifestations but its renal manifestations are not clearly defined. We aimed to evaluate renal complications of COVID-19 and their incidence using a systematic meta-analysis.DesignObservational studies reporting renal complications in COVID-19 patients were sought from MEDLINE, Embase and the Cochrane Library from 2019 to June 2020. The nine-star Newcastle-Ottawa Scale was used to evaluate methodological quality. Incidence with 95% confidence intervals (CIs) were pooled using random-effects models.ResultsWe included 22 observational cohort studies comprising of 17,391 COVID-19 patients. Quality scores of studies ranged from 4 to 6. The pooled prevalence of pre-existing chronic kidney disease (CKD) and end-stage kidney disease was 5.2% (2.8-8.1) and 2.3% (1.8-2.8), respectively. The pooled incidence over follow-up of 2-28 days was 12.5% (10.1-15.0) for electrolyte disturbance (e.g. hyperkalaemia), 11.0% (7.4-15.1) for acute kidney injury (AKI) and 6.8% (1.0-17.0) for renal replacement therapy (RRT). In subgroup analyses, there was a higher incidence of AKI in US populations and groups with higher prevalence of pre-existing CKD.ConclusionsFrequent renal complications reported among hospitalized COVID-19 patients are electrolyte disturbance, AKI and RRT. Aggressive monitoring and management of these renal complications may help in the prediction of favourable outcomes. Systematic review registration: PROSPERO 2020: CRD42020186873 KEY MESSAGES COVID-19 affects multiple organs apart from the respiratory system; however, its renal manifestations are not clearly defined. In this systematic meta-analysis of 22 observational cohort studies, the prevalence of pre-existing chronic kidney disease (CKD) in COVID-19 patients was 5.2%. The most frequent renal complication was electrolyte disturbance (particularly hyperkalaemia) with an incidence of 12.5% followed by acute kidney injury (AKI) with an incidence of 11.0%; US populations and groups with higher prevalence of CKD had higher incidence of AKI.
| S-EPMC7877945 | biostudies-literature
Project description: Not available
| S-EPMC7832225 | biostudies-literature