Purpose
SARS-CoV2 virus or COVID-19 has been associated with increased prothrombotic risk especially in the critical care setting, resulting in increased venous thromboembolism (VTE) related morbidity. The purpose of this study is to determine the incidence of VTE among patients with COVID-19 hospitalized in the United States and whether there is a need for more aggressive prophylaxis.
Materials and Methods
A comprehensive literature review of PubMed and Cochrane database from inception to September 2020 was performed for studies that evaluated the incidence of VTE, including pulmonary embolism (PE), and/or deep vein thrombosis (DVT) among COVID-19 patients hospitalized in the United States. We used “(Coronavirus OR COVID-19 OR SARS-Cov-2) AND (venous thromboembolism, VTE OR deep vein thrombosis, DVT OR pulmonary embolism (PE) )”. Finally, we screened reference lists from evaluated full texts. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Case reports and studies including cancer populations were excluded.
Results
A total of 973 patients hospitalized in the United States were included from, 3 multicenter and 2 single-center retrospective studies. Of those, 3 retrospective studies determined the incidence of VTE in critically ill patients only. Most studies reported universal in-hospital (95.3%). The overall incidence of VTE was 16.8% and 12% despite prophylactic anticoagulation. Interestingly, subgroup analysis in critically ill patients demonstrated an incidence of VTE of 27.5% and 26.5% despite prophylactic anticoagulation. The overall incidence of DVT was 7.3% and 22.5% in critically ill patients admitted to ICU. PE with or without DVT occurred in 9.5% of patients, 5% in critically ill patients and 2.9% was detected despite anticoagulation.
Conclusions
VTE was found at an alarming rate in hospitalized patients with COVID-19 in the United States and often presented as PE. Assessment of VTE risk is strongly recommended in patients with COVID-19. Given the observed higher than average pulmonary embolism incidence despite prophylactic anticoagulation, randomized trials are needed to determine whether there is any potential benefit of prophylactic IVC filter placement in patients with COVID-19, especially in the critical care setting.