Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis

Tan, Boun Kim; Mainbourg, Sabine; Friggeri, Arnaud; Bertoletti, Laurent; Douplat, Marion; Dargaud, Yesim; Grange, Claire; Lobbes, Hervé; Provencher, Steeve; Lega, Jean-Christophe

BACKGROUND: The prevalence of venous thromboembolic event (VTE) and arterial thromboembolic event (ATE) thromboembolic events in patients with COVID-19 remains largely unknown. METHODS: In this meta-analysis, we systematically searched for observational studies describing the prevalence of VTE and ATE in COVID-19 up to 30 September 2020. RESULTS: We analysed findings from 102 studies (64 503 patients). The frequency of COVID-19-related VTE was 14.7% (95% CI 12.1% to 17.6%, I(2)=94%; 56 studies; 16 507 patients). The overall prevalence rates of pulmonary embolism (PE) and leg deep vein thrombosis were 7.8% (95% CI 6.2% to 9.4%, I(2)=94%; 66 studies; 23 117 patients) and 11.2% (95% CI 8.4% to 14.3%, I(2)=95%; 48 studies; 13 824 patients), respectively. Few were isolated subsegmental PE. The VTE prevalence was significantly higher in intensive care unit (ICU) (23.2%, 95% CI 17.5% to 29.6%, I(2)=92%, vs 9.0%, 95% CI 6.9% to 11.4%, I(2)=95%; p(interaction)<0.0001) and in series systematically screening patients compared with series testing symptomatic patients (25.2% vs 12.7%, p(interaction)=0.04). The frequency rates of overall ATE, acute coronary syndrome, stroke and other ATE were 3.9% (95% CI 2.0% to to 3.0%, I(2)=96%; 16 studies; 7939 patients), 1.6% (95% CI 1.0% to 2.2%, I(2)=93%; 27 studies; 40 597 patients) and 0.9% (95% CI 0.5% to 1.5%, I(2)=84%; 17 studies; 20 139 patients), respectively. Metaregression and subgroup analyses failed to explain heterogeneity of overall ATE. High heterogeneity limited the value of estimates. CONCLUSIONS: Patients admitted in the ICU for severe COVID-19 had a high risk of VTE. Conversely, further studies are needed to determine the specific effects of COVID-19 on the risk of ATE or VTE in less severe forms of the disease.