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Venous thromboembolism in critically ill COVID-19 patients receiving prophylactic or therapeutic anticoagulation: a systematic review and meta-analysis.
J Thromb Thrombolysis. 2020 Nov; 50(4):814-821.JT

Abstract

Many aspects of care such as management of hypercoagulable state in COVID-19 patients, especially those admitted to intensive care units is challenging in the rapidly evolving pandemic of novel coronavirus disease 2019 (COVID-19). We seek to systematically review the available evidence regarding the anticoagulation approach to prevent venous thromboembolism (VTE) among COVID-19 patients admitted to intensive care units. Electronic databases were searched for studies reporting venous thromboembolic events in patients admitted to the intensive care unit receiving any type of anticoagulation (prophylactic or therapeutic). The pooled prevalence (and 95% confidence interval [CI]) of VTE among patients receiving anticoagulant were calculated using the random-effects model. Subgroup pooled analyses were performed with studies reported prophylactic anticoagulation alone and with studies reported mixed prophylactic and therapeutic anticoagulation. We included twelve studies (8 Europe; 2 UK; 1 each from the US and China) in our systematic review and meta-analysis. All studies utilized LMWH or unfractionated heparin as their pharmacologic thromboprophylaxis, either prophylactic doses or therapeutic doses. Seven studies reported on the proportion of patients with the previous history of VTE (range 0-10%). The pooled prevalence of VTE among ICU patients receiving prophylactic or therapeutic anticoagulation across all studies was 31% (95% CI 20-43%). Subgroup pooled analysis limited to studies reported prophylactic anticoagulation alone and mixed (therapeutic and prophylactic anticoagulation) reported pooled prevalences of VTE of 38% (95% CI 10-70%) and 27% (95% CI 17-40%) respectively. With a high prevalence of thromboprophylaxis failure among COVID-19 patients admitted to intensive care units, individualised rather than protocolised VTE thromboprophylaxis would appear prudent at interim.

Links

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Authors+Show Affiliations

Hasan SS
School of Applied Sciences, University of Huddersfield, Huddersfield, UK. s.hasan@hud.ac.uk.
Radford S
Intensive Care Unit, Austin Health, Melbourne, Australia. School of Medicine, University of Melbourne, Melbourne, Australia.
Kow CS
School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia.
Zaidi STR
School of Healthcare, University of Leeds, Leeds, UK. Leeds Teaching Hospitals Trust, Leeds, UK.

MeSH

AgedAnticoagulantsBetacoronavirusBlood CoagulationCOVID-19Coronavirus InfectionsCritical IllnessFemaleFibrinolytic AgentsHost-Pathogen InteractionsHumansMaleMiddle AgedPandemicsPneumonia, ViralRisk FactorsSARS-CoV-2Time FactorsTreatment OutcomeVenous Thromboembolism

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

32748122

Citation

Hasan, Syed Shahzad, et al. "Venous Thromboembolism in Critically Ill COVID-19 Patients Receiving Prophylactic or Therapeutic Anticoagulation: a Systematic Review and Meta-analysis." Journal of Thrombosis and Thrombolysis, vol. 50, no. 4, 2020, pp. 814-821.
Hasan SS, Radford S, Kow CS, et al. Venous thromboembolism in critically ill COVID-19 patients receiving prophylactic or therapeutic anticoagulation: a systematic review and meta-analysis. J Thromb Thrombolysis. 2020;50(4):814-821.
Hasan, S. S., Radford, S., Kow, C. S., & Zaidi, S. T. R. (2020). Venous thromboembolism in critically ill COVID-19 patients receiving prophylactic or therapeutic anticoagulation: a systematic review and meta-analysis. Journal of Thrombosis and Thrombolysis, 50(4), 814-821. https://doi.org/10.1007/s11239-020-02235-z
Hasan SS, et al. Venous Thromboembolism in Critically Ill COVID-19 Patients Receiving Prophylactic or Therapeutic Anticoagulation: a Systematic Review and Meta-analysis. J Thromb Thrombolysis. 2020;50(4):814-821. PubMed PMID: 32748122.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Venous thromboembolism in critically ill COVID-19 patients receiving prophylactic or therapeutic anticoagulation: a systematic review and meta-analysis. AU - Hasan,Syed Shahzad, AU - Radford,Sam, AU - Kow,Chia Siang, AU - Zaidi,Syed Tabish Razi, PY - 2020/8/5/pubmed PY - 2020/10/29/medline PY - 2020/8/5/entrez KW - Anticoagulation KW - COVID-19 KW - Coronavirus 2019 KW - Critically ill KW - Venous thromboembolism SP - 814 EP - 821 JF - Journal of thrombosis and thrombolysis JO - J Thromb Thrombolysis VL - 50 IS - 4 N2 - Many aspects of care such as management of hypercoagulable state in COVID-19 patients, especially those admitted to intensive care units is challenging in the rapidly evolving pandemic of novel coronavirus disease 2019 (COVID-19). We seek to systematically review the available evidence regarding the anticoagulation approach to prevent venous thromboembolism (VTE) among COVID-19 patients admitted to intensive care units. Electronic databases were searched for studies reporting venous thromboembolic events in patients admitted to the intensive care unit receiving any type of anticoagulation (prophylactic or therapeutic). The pooled prevalence (and 95% confidence interval [CI]) of VTE among patients receiving anticoagulant were calculated using the random-effects model. Subgroup pooled analyses were performed with studies reported prophylactic anticoagulation alone and with studies reported mixed prophylactic and therapeutic anticoagulation. We included twelve studies (8 Europe; 2 UK; 1 each from the US and China) in our systematic review and meta-analysis. All studies utilized LMWH or unfractionated heparin as their pharmacologic thromboprophylaxis, either prophylactic doses or therapeutic doses. Seven studies reported on the proportion of patients with the previous history of VTE (range 0-10%). The pooled prevalence of VTE among ICU patients receiving prophylactic or therapeutic anticoagulation across all studies was 31% (95% CI 20-43%). Subgroup pooled analysis limited to studies reported prophylactic anticoagulation alone and mixed (therapeutic and prophylactic anticoagulation) reported pooled prevalences of VTE of 38% (95% CI 10-70%) and 27% (95% CI 17-40%) respectively. With a high prevalence of thromboprophylaxis failure among COVID-19 patients admitted to intensive care units, individualised rather than protocolised VTE thromboprophylaxis would appear prudent at interim. SN - 1573-742X UR - https://www.unboundmedicine.com/medline/citation/32748122/Venous_thromboembolism_in_critically_ill_COVID_19_patients_receiving_prophylactic_or_therapeutic_anticoagulation:_a_systematic_review_and_meta_analysis_ DB - PRIME DP - Unbound Medicine ER -