key: cord-0754501-56t6i3as
authors: Whipple, Mary O.
title: Review of article: Porfidia, A., Valeriani, E., Pola, R., Porreca, E., Rutjes, A.W.S., Di Nisio, M. Venous thromboembolism in patients with COVID-19: Systematic review and meta-analysis. Thrombosis Research. 2020;196:67–74.
date: 2020-12-02
journal: J Vasc Nurs
DOI: 10.1016/j.jvn.2020.11.002
sha: 41e0816d438bca383540dabe3c16e2fe392748c2
doc_id: 754501
cord_uid: 56t6i3as

nan

Since it was first identified in late 2019, the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic of coronavirus disease (COVID-19). As of October 25, 2020, approximately 43 million people have been diagnosed with COVID-19 worldwide, and more than 1.15 million people have died. 1 The severity of COVID-19 varies greatly between patients, ranging from asymptomatic disease to acute respiratory distress syndrome, multi-organ failure, and death. 2 Research and clinical experience to date suggest that COVID-19 is associated with a hypercoagulable state, resulting in an increased risk of thromboembolic complications. 3 Specifically, venous thromboembolism (VTE), which includes pulmonary embolism (PE) and deep vein thrombosis (DVT), appears to be a common complication in patients with severe COVID-19 infection. Reports of the incidence and treatment of VTE in patients with COVID-19 are increasing rapidly, but these have been primarily limited to single-center experiences and estimates of the incidence of VTE in patients with COVID-19 vary widely.

A recent systematic review and meta-analysis by Porfidia et al 4 was one of the first to combine these data and seek to identify the incidence of VTE in patients with COVID-19 and identify subgroups of patients at elevated risk of VTE. The authors conducted a systematic search of MEDLINE, EMBASE, and PubMed to identify articles published between January 1, 2020 through June 24, 2020 that reported on VTE in hospitalized adult patients with COVID-19. In order to be eligible, publications were required to be in English and had to include at least 10 patients. Data on the country of origin; patient characteristics; anticoagulant treatment during hospitalization; and presentation, treatment, and type of VTE were abstracted from each publication. The primary study outcome was VTE (PE and DVT of upper or lower limbs). Incidence of PE or DVT alone was also examined, if reported. The incidence of VTE was assessed by hospital setting (intensive care unit [ICU] vs general care) and diagnostic protocol used for VTE diagnosis.

A total of 30 studies were eligible for inclusion in the review, reporting data on 3,487 patients. Study size ranged from 12 to 400 patients. The majority (80%) of included studies were conducted in Europe, the remainder were conducted in China (10%) and the United States (10%). Of the included patients (mean age ranged from 56 and 70 years, 62% male), 28% were admitted to the ICU. Overall, the incidence of VTE 26% (individual study incidence ranged from 0 to 85%), with a wide prediction interval of 6% to 66%. The incidence of PE with or without DVT was 12%, and the incidence of DVT alone was 14%. The authors found that there was a higher prevalence of VTE among patients admitted to the ICU when compared to general care (24% vs 9%). Only half of the included studies reported anticoagulant use. In those studies, 73.2% of patients received prophylactic doses, 8.0% of patients received intermediate does, and 16.8% of patients received therapeutic doses.

Although the heterogeneity of the included studies resulted in wide prediction intervals and relatively low quality evidence, the work of Porfidia et al 4 is an essential first step in understanding the scope of the problem of VTE in patients with COVID-19. Importantly, although the incidence of VTE is higher in patients admitted to the ICU, a significant number of patients admitted to general care (9%) also had VTE, despite use of anticoagulants. Thus, VTE presents a significant concern in patients with COVID-19. Additionally, the majority of cases of VTE were PE. The clinical presentation of PE may overlap with that of COVID-19 pneumonia and identification of Disclosures: The author declares that there is no conflict of interest.

PE symptoms may be difficult among patients who are already experiencing dyspnea. As a result, the available estimates may underestimate the true incidence of PE in patients with COVID-19.

The literature on the incidence and treatment of VTE in the setting of COVID-19 infection is rapidly evolving. The available data, although limited, provide critical insight into the problem of VTE in patients hospitalized with COVID-19. Given the frequency of VTE, it is important to improve education about VTE in COVID-19 for nurses and other health care workers. Care teams may also wish to consider a low threshold for referral for diagnostic imaging when VTE is suspected in hospitalized patients with COVID-19. It is unknown what patient characteristics or comorbidities may be associated with increased risk of VTE in the setting of COVID-19. As additional data become available, researchers should be better able to characterize the scope of the problem of VTE in COVID-19 and develop effective, novel methods for identifying and managing VTE risk.

Clinical characteristics of coronavirus disease 2019 in China

Prominent changes in blood coagulation of patients with SARS-CoV-2 infection

Venous thromboembolism in patients with COVID-19: Systematic review and meta-analysis

This publication was made possible by funding to Dr Whipple from the National Institute of Aging (NIA), NIH, United States (T32 AG000279, PI Schwartz). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agency.