Nopp Stephan, Moik Florian, Jilma Bernd, Pabinger Ingrid, Ay Cihan
Clinical Division of Haematology and Haemostaseology Department of Medicine I Medical University of Vienna Vienna Austria.
Department of Clinical Pharmacology Medical University of Vienna Vienna Austria.
Res Pract Thromb Haemost. 2020 Oct 13;4(7):1178-1191. doi: 10.1002/rth2.12439. eCollection 2020 Oct.
Venous thromboembolism (VTE) is frequently observed in patients with coronavirus disease 2019 (COVID-19). However, reported VTE rates differ substantially.
We aimed at evaluating available data and estimating the prevalence of VTE in patients with COVID-19.
We conducted a systematic literature search (MEDLINE, EMBASE, World Health Organization COVID-19 database) to identify studies reporting VTE rates in patients with COVID-19. Studies with suspected high risk of bias were excluded from quantitative synthesis. Pooled outcome rates were obtained within a random effects meta-analysis. Subgroup analyses were performed for different settings (intensive care unit [ICU] vs non-ICU hospitalization and screening vs no screening) and the association of d-dimer levels and VTE risk was explored.
Eighty-six studies (33,970 patients) were identified and 66 (28,173 patients, mean age: 62.6 years, 60.1% men, 19.4% ICU patients) were included in quantitative analysis. The overall VTE prevalence estimate was 14.1% (95% confidence interval [CI], 11.6-16.9), 40.3% (95% CI, 27.0-54.3) with ultrasound screening and 9.5% (95% CI, 7.5-11.7) without screening. Subgroup analysis revealed high heterogeneity, with a VTE prevalence of 7.9% (95% CI, 5.1-11.2) in non-ICU and 22.7% (95% CI, 18.1-27.6) in ICU patients. Prevalence of pulmonary embolism (PE) in non-ICU and ICU patients was 3.5% (95% CI, 2.2-5.1) and 13.7% (95% CI, 10.0-17.9). Patients developing VTE had higher d-dimer levels (weighted mean difference, 3.26 µg/mL; 95% CI, 2.76-3.77) than non-VTE patients.
VTE occurs in 22.7% of patients with COVID-19 in the ICU, but VTE risk is also increased in non-ICU hospitalized patients. Patients developing VTE had higher d-dimer levels. Studies evaluating thromboprophylaxis strategies in patients with COVID-19 are needed to improve prevention of VTE.
2019冠状病毒病（COVID-19）患者中经常观察到静脉血栓栓塞症（VTE）。然而，报告的VTE发生率差异很大。
我们旨在评估现有数据并估计COVID-19患者中VTE的患病率。
我们进行了系统的文献检索（MEDLINE、EMBASE、世界卫生组织COVID-19数据库），以识别报告COVID-19患者VTE发生率的研究。存在高偏倚风险的研究被排除在定量综合分析之外。在随机效应荟萃分析中获得合并结局率。针对不同情况（重症监护病房[ICU]与非ICU住院以及筛查与未筛查）进行亚组分析，并探讨D-二聚体水平与VTE风险的关联。
共识别出86项研究（33970例患者），66项研究（28173例患者，平均年龄：62.6岁，男性占60.1%，ICU患者占19.4%）纳入定量分析。总体VTE患病率估计为14.1%（95%置信区间[CI]，11.6 - 16.9），超声筛查时为40.3%（95% CI，27.0 - 54.3），未筛查时为9.5%（95% CI，7.5 - 11.7）。亚组分析显示异质性较高，非ICU患者的VTE患病率为7.9%（95% CI，5.1 - 11.2），ICU患者为22.7%（95% CI，18.1 - 27.6）。非ICU和ICU患者的肺栓塞（PE）患病率分别为3.5%（95% CI，2.2 - 5.1）和13.7%（95% CI，10.0 - 17.9）。发生VTE的患者D-二聚体水平高于未发生VTE的患者（加权平均差，3.26μg/mL；95% CI，2.76 - 3.77）。
ICU中22.7%的COVID-19患者发生VTE，但非ICU住院患者的VTE风险也增加。发生VTE的患者D-二聚体水平较高。需要开展评估COVID-19患者血栓预防策略的研究，以改善VTE的预防。
