High rates of pulmonary artery occlusions in COVID‐19. A meta‐analysis

Background COVID‐19 patients are considered at high risk of venous thromboembolism (VTE). The real nature of pulmonary artery occlusions (PAO) in COVID‐19 has been questioned, suggesting that it is caused also by in situ thrombi, rather than only by emboli (PE) from peripheral thrombi. Methods We se...

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Vydáno v:European journal of clinical investigation Ročník 51; číslo 1; s. e13433 - n/a
Hlavní autoři: Birocchi, Simone, Manzoni, Marco, Podda, Gian Marco, Casazza, Giovanni, Cattaneo, Marco
Médium: Journal Article
Jazyk:angličtina
Vydáno: England Blackwell Publishing Ltd 01.01.2021
John Wiley and Sons Inc
Témata:
Anticoagulants - therapeutic use
Case-Control Studies
COVID-19
COVID-19 - epidemiology
embolism and thrombosis
Heparin
Heparin - therapeutic use
Heparin, Low-Molecular-Weight - therapeutic use
Humans
low‐molecular‐weight heparin
Meta-analysis
Original
Original Papers
Prevalence
Pulmonary arteries
Pulmonary Artery
Pulmonary Embolism - epidemiology
Pulmonary Embolism - prevention & control
SARS coronavirus
SARS-CoV-2
Thromboembolism
Thrombosis
Thrombosis - epidemiology
Thrombosis - prevention & control
Venous Thrombosis - epidemiology
Venous Thrombosis - prevention & control
COVID-19
low-molecular-weight heparin
embolism and thrombosis
SARS coronavirus
ISSN:0014-2972, 1365-2362, 1365-2362
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Shrnutí:Background COVID‐19 patients are considered at high risk of venous thromboembolism (VTE). The real nature of pulmonary artery occlusions (PAO) in COVID‐19 has been questioned, suggesting that it is caused also by in situ thrombi, rather than only by emboli (PE) from peripheral thrombi. Methods We searched MEDLINE for studies published until 6 June 2020 that included COVID‐19 patients or non‐COVID‐19 medical patients at VTE risk, treated with heparins, in whom VTE (PE and deep vein thrombosis, DVT) had been reported. Systematic review and results reporting were conducted in accordance with PRISMA guidelines. Data were independently extracted by two observers, and estimates were pooled using random‐effects meta‐analysis. Results We identified 17 studies including 3224 COVID‐19 patients and 7 including 11 985 non‐COVID‐19 patients. Two analyses were performed: in all COVID‐19 patients and only in those (n = 515) who, like non‐COVID‐19 patients, were screened systematically for DVT. The latter analysis revealed that the prevalence of DVT was 15.43% (95%CI, 4.08‐31.77) in COVID‐19 and 4.21% (2.27‐6.68) in non‐COVID‐19 patients (P = .0482). The prevalence of PE was 4.85% (40.33‐13.01) in COVID‐19 patients and 0.22% (0.03‐0.55) in non‐COVID‐19 patients (P = .0128). The percentage of PE among VTE events was 22.15% (5.31‐44.60) in COVID‐19 and 6.39% (3.17‐10.41) in non‐COVID‐19 patients (P = .0482). Differences were even more marked when all COVID‐19 patients were analysed. Conclusions The results of our meta‐analysis highlight a disproportion in the prevalence of PE among all VTE events in COVID 19 patients, likely reflecting PAO by pulmonary thrombi, rather than emboli from peripheral vein thrombi.
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Simone Birocchi and Marco Manzoni contributed equally to this study.
ISSN:0014-2972
1365-2362
1365-2362
DOI:10.1111/eci.13433