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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Published in:	European journal of clinical investigation Vol. 51; no. 1; pp. e13433 - n/a
Main Authors:	Birocchi, Simone, Manzoni, Marco, Podda, Gian Marco, Casazza, Giovanni, Cattaneo, Marco
Format:	Journal Article
Language:	English
Published:	England Blackwell Publishing Ltd 01.01.2021 John Wiley and Sons Inc
Subjects:	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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Abstract	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.
AbstractList	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.BACKGROUNDCOVID-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.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.METHODSWe 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.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.RESULTSWe 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.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.CONCLUSIONSThe 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. BackgroundCOVID‐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.MethodsWe 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.ResultsWe 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.ConclusionsThe 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. 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. 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. 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. 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. 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.
Author	Casazza, Giovanni Birocchi, Simone Podda, Gian Marco Manzoni, Marco Cattaneo, Marco
AuthorAffiliation	2 Dipartimento di Scienze Biomediche e Cliniche L. Sacco Università degli Studi di Milano Milano Italy 1 Unità di Medicina II ASST Santi Paolo e Carlo ‐ Dipartimento di Scienze della Salute Università degli Studi di Milano Milano Italy
AuthorAffiliation_xml	– name: 2 Dipartimento di Scienze Biomediche e Cliniche L. Sacco Università degli Studi di Milano Milano Italy – name: 1 Unità di Medicina II ASST Santi Paolo e Carlo ‐ Dipartimento di Scienze della Salute Università degli Studi di Milano Milano Italy
Author_xml	– sequence: 1 givenname: Simone surname: Birocchi fullname: Birocchi, Simone organization: Università degli Studi di Milano – sequence: 2 givenname: Marco surname: Manzoni fullname: Manzoni, Marco organization: Università degli Studi di Milano – sequence: 3 givenname: Gian Marco surname: Podda fullname: Podda, Gian Marco organization: Università degli Studi di Milano – sequence: 4 givenname: Giovanni surname: Casazza fullname: Casazza, Giovanni organization: Università degli Studi di Milano – sequence: 5 givenname: Marco orcidid: 0000-0002-7343-4534 surname: Cattaneo fullname: Cattaneo, Marco email: marco.cattaneo@unimi.it organization: Università degli Studi di Milano
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Keywords	COVID-19 low-molecular-weight heparin embolism and thrombosis SARS coronavirus
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Snippet	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... 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... BackgroundCOVID‐19 patients are considered at high risk of venous thromboembolism (VTE). The real nature of pulmonary artery occlusions (PAO) in COVID‐19 has...
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SubjectTerms	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
Title	High rates of pulmonary artery occlusions in COVID‐19. A meta‐analysis
URI	https://onlinelibrary.wiley.com/doi/abs/10.1111%2Feci.13433 https://www.ncbi.nlm.nih.gov/pubmed/33053206 https://www.proquest.com/docview/2470495019 https://www.proquest.com/docview/2451380540 https://pubmed.ncbi.nlm.nih.gov/PMC7646003
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