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Venous Thromboembolism in Hospitalized COVID-19 Patients.
Am J Ther. 2020 Nov/Dec; 27(6):e599-e610.AJ

Abstract

BACKGROUND

Venous thromboembolism (VTE) is increasingly reported in seriously ill patients with COVID-19 infection. Incidence of VTE has been reported before and results varied widely in study cohorts.

AREA OF UNCERTAINTY

Incidence of major VTE (segmental pulmonary embolism and above and proximal deep vein thrombosis) which is a contributor to mortality and morbidity is not known. Also, data is unclear on the optimal anticoagulation regimen to prevent VTE.

DATA SOURCES

Multiple databases including PubMed were searched until May 12, 2020, to include studies reporting VTE in hospitalized COVID-19 adult patients. MOOSE guidelines were followed in selection, and 11 studies were included. We conducted a systematic review and meta-analysis to quantitatively assess the VTE burden in hospitalized COVID-19 patients and potential benefits of therapeutic dosing of anticoagulation compared with prophylaxis dosing for VTE prevention.

THERAPEUTIC ADVANCES

Many societies and experts recommend routine prophylactic anticoagulation with heparin for VTE prevention in hospitalized COVID-19 patients. In this meta-analysis, the pooled rate of major VTE was 12.5% in hospitalized patients and 17.2% in intensive care unit patients. When therapeutic anticoagulation dosing was compared with prophylactic anticoagulation, the pooled odds ratio of VTE was 0.33 (95% confidence interval 0.14-0.75; P = 0.008, I = 0%) suggesting statistical significance with therapeutic dosing of anticoagulation for primary prevention of VTE in all hospitalized patients. However, this should be interpreted with caution as the bleeding events and safety profile could not be ascertained because of lack of adequate information. We recommend applying this finding to hospitalized COVID 19 patients only after carefully weighing individual bleeding risks and benefits.

CONCLUSION

Major VTE events, especially pulmonary embolism, seem to be high in COVID-19 patients admitted to the intensive care unit. Therapeutic anticoagulation dosing seems to significantly benefit the odds of preventing any VTE when compared with prophylactic dosing in all hospitalized patients.

Authors+Show Affiliations

Department of Medicine, University of Arizona/Banner University Medical Center, Tucson, AZ.Department of Oncology, Sanford Health /University of North Dakota School of Medicine and Health Sciences, Fargo, ND.Department of Medicine, University of Arizona/Banner University Medical Center, Tucson, AZ.Department of Medicine, Woodlands Health Campus, Singapore.Department of Medicine, Westchester Medical Center, Valhalla, NY.Department of Medicine, Section of Gastroenterology, Rush University Medical Center, Chicago, IL.Department of Internal Medicine, Carilion Clinic, Roanoke, VA.Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY.Department of Critical Care Medicine, Mercy Hospital, Saint Louis University, St Louis, MO.Department of Medicine, Division of Nephrology, University of Florida, Gainesville, FL; and.Department of Medicine, Division of Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, UT.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

33156016

Citation

Sridharan, Gurusaravanan Kutti, et al. "Venous Thromboembolism in Hospitalized COVID-19 Patients." American Journal of Therapeutics, vol. 27, no. 6, 2020, pp. e599-e610.
Sridharan GK, Vegunta R, Rokkam VRP, et al. Venous Thromboembolism in Hospitalized COVID-19 Patients. Am J Ther. 2020;27(6):e599-e610.
Sridharan, G. K., Vegunta, R., Rokkam, V. R. P., Meyyur Aravamudan, V., Vegunta, R., Khan, S. R., Ponnada, S., Boregowda, U., Prudhvi, K., Chamarthi, G., & Mohan, B. P. (2020). Venous Thromboembolism in Hospitalized COVID-19 Patients. American Journal of Therapeutics, 27(6), e599-e610. https://doi.org/10.1097/MJT.0000000000001295
Sridharan GK, et al. Venous Thromboembolism in Hospitalized COVID-19 Patients. Am J Ther. 2020 Nov/Dec;27(6):e599-e610. PubMed PMID: 33156016.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Venous Thromboembolism in Hospitalized COVID-19 Patients. AU - Sridharan,Gurusaravanan Kutti, AU - Vegunta,Radhakrishna, AU - Rokkam,Venkata Ram Pradeep, AU - Meyyur Aravamudan,Veeraraghavan, AU - Vegunta,Rathnamitreyee, AU - Khan,Shahab R, AU - Ponnada,Suresh, AU - Boregowda,Umesha, AU - Prudhvi,Kalyan, AU - Chamarthi,Gajapathiraju, AU - Mohan,Babu P, PY - 2020/11/6/entrez PY - 2020/11/7/pubmed PY - 2020/11/18/medline SP - e599 EP - e610 JF - American journal of therapeutics JO - Am J Ther VL - 27 IS - 6 N2 - BACKGROUND: Venous thromboembolism (VTE) is increasingly reported in seriously ill patients with COVID-19 infection. Incidence of VTE has been reported before and results varied widely in study cohorts. AREA OF UNCERTAINTY: Incidence of major VTE (segmental pulmonary embolism and above and proximal deep vein thrombosis) which is a contributor to mortality and morbidity is not known. Also, data is unclear on the optimal anticoagulation regimen to prevent VTE. DATA SOURCES: Multiple databases including PubMed were searched until May 12, 2020, to include studies reporting VTE in hospitalized COVID-19 adult patients. MOOSE guidelines were followed in selection, and 11 studies were included. We conducted a systematic review and meta-analysis to quantitatively assess the VTE burden in hospitalized COVID-19 patients and potential benefits of therapeutic dosing of anticoagulation compared with prophylaxis dosing for VTE prevention. THERAPEUTIC ADVANCES: Many societies and experts recommend routine prophylactic anticoagulation with heparin for VTE prevention in hospitalized COVID-19 patients. In this meta-analysis, the pooled rate of major VTE was 12.5% in hospitalized patients and 17.2% in intensive care unit patients. When therapeutic anticoagulation dosing was compared with prophylactic anticoagulation, the pooled odds ratio of VTE was 0.33 (95% confidence interval 0.14-0.75; P = 0.008, I = 0%) suggesting statistical significance with therapeutic dosing of anticoagulation for primary prevention of VTE in all hospitalized patients. However, this should be interpreted with caution as the bleeding events and safety profile could not be ascertained because of lack of adequate information. We recommend applying this finding to hospitalized COVID 19 patients only after carefully weighing individual bleeding risks and benefits. CONCLUSION: Major VTE events, especially pulmonary embolism, seem to be high in COVID-19 patients admitted to the intensive care unit. Therapeutic anticoagulation dosing seems to significantly benefit the odds of preventing any VTE when compared with prophylactic dosing in all hospitalized patients. SN - 1536-3686 UR - https://www.unboundmedicine.com/medline/citation/33156016/Venous_Thromboembolism_in_Hospitalized_COVID_19_Patients_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=33156016.ui DB - PRIME DP - Unbound Medicine ER -