Table 1.
Attributes of the 19 Studies Included in the Meta-Analysis
| Author | Study Period | Type of Study | # VTE/Total patients (%) | Mean age | Sex | Thromboprophylaxis (type/dose) | Clinical course |
|---|---|---|---|---|---|---|---|
| Stoneham SM, et al. [21] | Mar 20-Apr 9, 2020 (20 days) | Case-control study | 21/274 (8%) |
VTE-positive 67 ± 12 years VTE-negative 65 ± 15 years |
VTE-positive: Men 67% VTE-negative: Men 57% |
3 patients given weight-based treatment with LMWH | Overall all-cause mortality rate 27.7% |
| Zhang L, et al. [22] | Jan 29-Feb 29, 2020 (31 days) | Retrospective cohort study | 66/143 (46%) | 63 ± 14 years |
Men 52% Women 48% |
37.1% patients given DVT prophylaxis; 41.3% patients received LMWH after positive ultrasound studies for DVT | 10.5% patients were admitted to the ICU. DVT patients > 65 years (66.7% vs 41.6%) and critically ill (65.2% vs 28.6%). |
| Cui S, et al. [23] | Jan 30-Mar 22, 2020 (23 days) | Cohort study, risk analysis | 20/81 (25%) | 59.9 ± 14.1 years |
Men 46% Women 54% |
No preventive anticoagulant was administered | All admitted to ICU. 41% patients had chronic medical illness. D-dimer level was a good index for predicting VTE. |
| Klok FA, et al. [24] | Mar 7-Apr 5, 2020 (29 days) | Prospective cohort study | 75/184 (39%) | 64 ± 12 years |
Men 76% Women 24% |
All patients received pharmacological thromboprophylaxis per local hospital | VTE patients at higher risk of all-cause death (HR 5.4). Anticoagulation lowers risk HR 0.29; all-cause death (HR 0.79, 95%CI 0.35–1.8). |
| Demelo-Rodríguez P, et al. [25] | mid-April 2020 | Prospective observational study | 23/156 (15%) | 68.1 ± 14.5 years |
Men 65% Women 35% |
All patients received standard doses of thromboprophylaxis, except 3 patients with high bleeding risk | Asymptomatic patients not in-ICU with COVID- 19 |
| Pavoni V, et al. [26] | Feb 28-Apr 10, 2020 (11 days) | Retrospective, observational study | 20/40 (50%) | 61 ± 13 years |
Men 60% Women 40% |
All patients received thromboprophylaxis with low molecular weight heparin | DVT) in 6 patients (15%) and TBE 2 patients (5%); 12 patients (30%) had a catheter thrombosis |
| Middeldorp S, et al. [27] | Mar 2-Apr 12, 2020 (41 days) | In-patient cohort study | 39/198 (20%) | 61 years |
Men 66% Women 34% |
Ward patients received thrombosis prophylaxis with nadroparin. ICU received a double dose of nadroparin | VTE 47% ICU patients, 3% of wards |
| Lodigiani C, et al. [28] | Feb 13-Apr 10, 2020 (26 days) | Retrospective study | 60/388 (21%) | 66 (55–85) years |
Men 80% Women 20% |
All ICU patients received LMWH; general wards: prophylactic 41, 21% intermediate-, 23% therapeutic dose. | Older patients dying during hospitalization (OR 1.10; 95%CI 1.07–1.13). VTE, 27.6% ICU, 6.6% general ward |
| Llitjos JF, et al. [29] | Mar 19-Aprl 11, 2020 (23 days) | Retrospective cohort study | 68 (51.5–74.5) |
Men 77% Women 23% |
31% treated with prophylactic dose, 69% with therapeutic dose | All ICU patients. 56% with VTE | |
| Helms J, et al. [30] | Mar 3-Mar 31, 2020 (28 days) | Multicenter prospective cohort | 63 [53; 71] years |
Men 81% Women 19% |
70% prophylactic dose, 30% therapeutic dose | All ICU patients. PE16.7%. COVID-19 ARDS patients developed had more VTE (11.7 vs. 2.1%) | |
| Koleilat I, et al. [31] | Mar 1-Apr 10, 2020 (40 days) | Single center retrospective case-control study | 18/26 (69%) |
DVT positive - 59 years DVT negative - 64 years |
Men 52% Women 48% |
12/18 with chemical thromboprophylaxis; 2/18 therapeutic anticoagulation developed DVT | DVT 10.1% either SARS-CoV-2 negative or untested. More COVID-19 patients with DVT |
| Zerwes S, et al. [32] | Apr 18-Apr 30, 2020 (12 days) | Prospective single center study | 64/150 (43%) | Mean for all patients 67 years; COVID-19 patients 62 years, non-COVID-19 patients 69 years | No information |
Anticoagulation: 9 prophylactic (6 COVID) 3 sub-therapeutic 5 therapeutic. |
ICU patients: 20 COVID-19-positive patients compared with 20 non-COVID-19 patients. Elevated D-dimer levels. |
| Thomas W, et al. [33] | Days of observation =8 (range 1–28) | Observational study | 17/63 (27%) | Estimated average age 61 years |
Men 69% Women 31% |
Prophylactic dalteparin adjusted for weight and renal function or unfractionated heparin | All ICU patients. At censor date: Still in ICU 44%; In ward or discharged 32%; Dead 16% |
| Nahum J, et al. [34] | Mid-Mar to early Apr 2020 (21 days) | Prospective single center study | 27/34 (79%) | 62.2 ± 8.6 years |
Men 78% Women 22% |
All patients received anticoagulant prophylaxis at hospital admission | All in ICU. VTE 65% at admission, 79% 48 h after |
| Longchamp A, et al. [35] | Marc 8-Apr 4, 2020 | Retrospective review | 8/25 (32%) | 68 ± 11 years |
Men 64% Women 36% |
Therapeutic anticoagulation only in patients with VTE |
Discharged 72% In hospital ICU 2% Dead 20% |
| Gervaise A, et al. [36] | Mar 14-Apr 6, 2020 (23 days) | Retrospective review | 13/72 (18%) |
APE 74.4 years ±15.0 non-APE 59.6 years ±17.4 |
Men 75% Women 25% |
Unknown |
Discharged 38 (53%) In hospital 23 (32%) Dead 11 (15%) |
| Mestre-Gómez B, et al. [37] | Mar 30-Apr 12, 2020 (13 days) | Retrospective review | 29/91 (32%) | 65 years (56–73) |
Men 72% Women 28% |
Most patients diagnosed with PE received LMWH, 79.3% | Discharged 82.7%; Still In hospital 13.8%; ICU 6.9%; Dead 3.4% |
| Inciardi RM, et al. [38] | Mar 4, 2020-Mar 25, 2020 (21 days) | Prospective cohort study | 15/99 (15%) | 67 ± 12 years |
Men 81%) Women 19% |
Anticogulation not routinely given to patients in sinus rhythm |
VTE higher in cardiac patients (23% vs. 6%) Mortality higher in cardiac patients (36% vs. 15%) |
| Soumagne T, et al. [39] | Mar 10-Apr 12, 2020 (33 days) | Retrospective review | 56/375 (15%) |
With PE: 61.1 ± 9.1 years Without PE: 63.5 ± 10.1 years |
With PE: Men 84% Without PE: Men 76% |
All patients given anticoagulation at preventive dose |
Patients with PE vs. Pts without PE ICU mortality day 14: 16% vs. 26%) p = 0.13 ICU mortality day 28: 29% vs. 37%) p = 0.27 Extubated day 28: 49% vs. 68% p = 0.25 |
Abbreviations used in Table 1: APE Acute pulmonary embolism, DVT Deep vein thrombosis; HR Hazard Ratio, LMWH Low molecular weight heparin, OR Odds ratio, PE Pulmonary embolism, SOFA Sepsis-related Organ Failure Assessment, vs Versus