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Venous thromboembolism in COVID-19: systematic review of reported risks and current guidelines.
Swiss Med Wkly. 2020 06 15; 150:w20301.SM

Abstract

AIMS OF THE STUDY

Many centres have noticed a high number of venous thromboembolism (VTE) events among critically ill inpatients with COVID-19 pneumonia. The aims of this study were (1) to summarise the reported risk of VTE associated with COVID-19 infections and (2) to summarise guidance documents on thromboprophylaxis in COVID-19 patients, in a systematic review.

METHODS

We systematically searched for peer-reviewed evidence on the risk of VTE in patients with COVID-19, in PubMed, Embase and Twitter, and for guidelines or guidance documents for thromboprophylaxis, from international or national societies relevant to the field of thrombosis and haemostasis, up to April 30 2020.

RESULTS

We found 11 studies (1 clinical trial, 7 retrospective cohorts and 3 prospective cohorts), which included a range of 16 to 388 in patients with COVID-19 (total of 1369 inpatients). The diagnoses of COVID-19 and VTE were of high quality, but the follow-up was often unclear. Most studies reported universal in-hospital thromboprophylaxis. Among all inpatients and among intensive care unit (ICU) inpatients with COVID-19, reported risks of VTE were 4.4–8.2% (three studies) and 0–35.3% (six studies), respectively. Two studies at least partially screened for VTE in ICU inpatients with COVID-19, and found risks of 24.7–53.8%. We found 12 guidelines for thromboprophylaxis of COVID-19 patients. The majority suggested universal pharmacological thromboprophylaxis in all COVID-19 inpatients, but there was heterogeneity in the suggested intensity of thromboprophylaxis: seven advised considering intensified doses of heparin according to the clinical or biological severity of the disease, especially in the ICU setting.

CONCLUSIONS

Venous thromboembolism very commonly complicates the clinical course of inpatients with COVID-19, despite thromboprophylaxis. The risk appears highest among critically ill inpatients. We found no estimates of risks among outpatients. Many questions remain unresolved, as delineated by the heterogeneity of national and international guidelines. This situation calls for fast randomised clinical trials, comparing different schemes of thromboprophylaxis in COVID-19 inpatients.

Authors+Show Affiliations

Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.

Pub Type(s)

Journal Article
Systematic Review

Language

eng

PubMed ID

32640479

Citation

Fontana, Pierre, et al. "Venous Thromboembolism in COVID-19: Systematic Review of Reported Risks and Current Guidelines." Swiss Medical Weekly, vol. 150, 2020, pp. w20301.
Fontana P, Casini A, Robert-Ebadi H, et al. Venous thromboembolism in COVID-19: systematic review of reported risks and current guidelines. Swiss Med Wkly. 2020;150:w20301.
Fontana, P., Casini, A., Robert-Ebadi, H., Glauser, F., Righini, M., & Blondon, M. (2020). Venous thromboembolism in COVID-19: systematic review of reported risks and current guidelines. Swiss Medical Weekly, 150, w20301. https://doi.org/10.4414/smw.2020.20301
Fontana P, et al. Venous Thromboembolism in COVID-19: Systematic Review of Reported Risks and Current Guidelines. Swiss Med Wkly. 2020 06 15;150:w20301. PubMed PMID: 32640479.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Venous thromboembolism in COVID-19: systematic review of reported risks and current guidelines. AU - Fontana,Pierre, AU - Casini,Alessandro, AU - Robert-Ebadi,Helia, AU - Glauser,Frederic, AU - Righini,Marc, AU - Blondon,Marc, Y1 - 2020/06/21/ PY - 2020/7/9/entrez PY - 2020/7/9/pubmed PY - 2020/7/18/medline SP - w20301 EP - w20301 JF - Swiss medical weekly JO - Swiss Med Wkly VL - 150 N2 - AIMS OF THE STUDY: Many centres have noticed a high number of venous thromboembolism (VTE) events among critically ill inpatients with COVID-19 pneumonia. The aims of this study were (1) to summarise the reported risk of VTE associated with COVID-19 infections and (2) to summarise guidance documents on thromboprophylaxis in COVID-19 patients, in a systematic review. METHODS: We systematically searched for peer-reviewed evidence on the risk of VTE in patients with COVID-19, in PubMed, Embase and Twitter, and for guidelines or guidance documents for thromboprophylaxis, from international or national societies relevant to the field of thrombosis and haemostasis, up to April 30 2020. RESULTS: We found 11 studies (1 clinical trial, 7 retrospective cohorts and 3 prospective cohorts), which included a range of 16 to 388 in patients with COVID-19 (total of 1369 inpatients). The diagnoses of COVID-19 and VTE were of high quality, but the follow-up was often unclear. Most studies reported universal in-hospital thromboprophylaxis. Among all inpatients and among intensive care unit (ICU) inpatients with COVID-19, reported risks of VTE were 4.4–8.2% (three studies) and 0–35.3% (six studies), respectively. Two studies at least partially screened for VTE in ICU inpatients with COVID-19, and found risks of 24.7–53.8%. We found 12 guidelines for thromboprophylaxis of COVID-19 patients. The majority suggested universal pharmacological thromboprophylaxis in all COVID-19 inpatients, but there was heterogeneity in the suggested intensity of thromboprophylaxis: seven advised considering intensified doses of heparin according to the clinical or biological severity of the disease, especially in the ICU setting. CONCLUSIONS: Venous thromboembolism very commonly complicates the clinical course of inpatients with COVID-19, despite thromboprophylaxis. The risk appears highest among critically ill inpatients. We found no estimates of risks among outpatients. Many questions remain unresolved, as delineated by the heterogeneity of national and international guidelines. This situation calls for fast randomised clinical trials, comparing different schemes of thromboprophylaxis in COVID-19 inpatients. SN - 1424-3997 UR - https://www.unboundmedicine.com/medline/citation/32640479/Venous_thromboembolism_in_COVID_19:_systematic_review_of_reported_risks_and_current_guidelines_ L2 - https://doi.emh.ch/10.4414/smw.2020.20301 DB - PRIME DP - Unbound Medicine ER -