Malas Mahmoud B, Naazie Isaac N, Elsayed Nadin, Mathlouthi Asma, Marmor Rebecca, Clary Bryan
Department of Surgery, University of California San Diego Health System, San Diego, CA 92093, United States.
EClinicalMedicine. 2020 Dec;29:100639. doi: 10.1016/j.eclinm.2020.100639. Epub 2020 Nov 20.
Studies have suggested that there is increased risk of thromboembolism (TE) associated with coronavirus disease 2019 (COVID-19). However, overall arterial and venous TE rates of COVID-19 and effect of TE on COVID-19 mortality is unknown.
We did a systematic review and meta-analysis of studies evaluating TE in COVID-19. We searched PubMed, Cochrane, and Embase for studies published up to June 12, 2020. Random effects models were used to produce summary TE rates and odds ratios (OR) of mortality in COVID-19 patients with TE compared to those without TE. Heterogeneity was quantified with
Of 425 studies identified, 42 studies enrolling 8271 patients were included in the meta-analysis. Overall venous TE rate was 21% (95% CI:17-26%): ICU, 31% (95% CI: 23-39%). Overall deep vein thrombosis rate was 20% (95% CI: 13-28%): ICU, 28% (95% CI: 16-41%); postmortem, 35% (95% CI:15-57%). Overall pulmonary embolism rate was 13% (95% CI: 11-16%): ICU, 19% (95% CI:14-25%); postmortem, 22% (95% CI:16-28%). Overall arterial TE rate was 2% (95% CI: 1-4%): ICU, 5% (95%CI: 3-7%). Pooled mortality rate among patients with TE was 23% (95%CI:14-32%) and 13% (95% CI:6-22%) among patients without TE. The pooled odds of mortality were 74% higher among patients who developed TE compared to those who did not (OR, 1.74; 95%CI, 1.01-2.98; = 0.04).
TE rates of COVID-19 are high and associated with higher risk of death. Robust evidence from ongoing clinical trials is needed to determine the impact of thromboprophylaxis on TE and mortality risk of COVID-19.
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研究表明，2019冠状病毒病（COVID-19）相关的血栓栓塞（TE）风险增加。然而，COVID-19的总体动脉和静脉TE发生率以及TE对COVID-19死亡率的影响尚不清楚。
我们对评估COVID-19中TE的研究进行了系统评价和荟萃分析。我们在PubMed、Cochrane和Embase中检索截至2020年6月12日发表的研究。采用随机效应模型得出COVID-19合并TE患者与未合并TE患者的TE总发生率和死亡率比值比（OR）。用异质性进行量化
在确定的425项研究中，42项纳入8271例患者的研究被纳入荟萃分析。总体静脉TE发生率为21%（95%CI：17-26%）；在重症监护病房（ICU）为31%（95%CI：23-39%）。总体深静脉血栓形成率为20%（95%CI：13-28%）；在ICU为28%（95%CI：16-41%）；尸检时为35%（95%CI：15-57%）。总体肺栓塞率为13%（95%CI：11-16%）；在ICU为19%（95%CI：14-25%）；尸检时为22%（95%CI：16-28%）。总体动脉TE发生率为2%（95%CI：1-4%）；在ICU为5%（95%CI：3-7%）。TE患者的合并死亡率为23%（95%CI：14-32%），未发生TE患者的合并死亡率为13%（95%CI：6-22%）。发生TE的患者与未发生TE的患者相比，合并死亡几率高74%（OR，1.74；95%CI，1.01-2.98；P = 0.04）。
COVID-19的TE发生率很高，且与更高的死亡风险相关。需要正在进行的临床试验的有力证据来确定血栓预防对COVID-19的TE和死亡风险的影响。
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