Venous thromboembolism is linked to severity of disease in COVID-19 patients: A systematic literature review and exploratory meta-analysis.

Srivastava, Rashmi; Parveen, Rizwana; Mishra, Pinki; Saha, Nilanjan; Bajpai, Ram; Agarwal, Nidhi Bharal

PURPOSE Coronavirus disease-2019 (COVID-19) may predispose to venous thromboembolism (VTE) and arterial thromboembolism due to excessive inflammation, hypoxia, immobilization and diffuse intravascular coagulation. The understanding of the association might be helpful in early vigilant monitoring and better management of COVID-19 patients at a high risk. Thus, in this meta-analysis we aim to assess the association of venous thromboembolism with severity of COVID-19 disease. METHODS A literature search was conducted on PubMed and Cochrane Central Register of Controlled Trials using the keywords "COVID-19 and thromboembolism" and "COVID-19 and embolism", till 20 February 2021. Thirteen studies including 6648 COVID-19 patients were incorporated in this systematic review and exploratory meta- analysis. RESULTS The analysis revealed nearly three times more risk of intensive care unit (ICU) care in patients with venous thromboembolism (VTE) compared to non-VTE patients (RR: 2.78; 95% CI: 1.75- 4.39; p <0.001; I2 : 65.1 %). Patients with pulmonary embolism and deep vein thrombosis are at increased risk of being admitted to ICU (RR: 2.21; 95% CI: 1.86-2.61; p<0.001; I2 :41.2%) and (RR: 2.69; 95 % CI: 2.37-3.06; p <0.001; I2 : 0.0 %), respectively. The quality assessment indicated that the included studies were of fair quality. CONCLUSIONS Our findings suggest that venous thromboembolism either deep vein thrombosis or pulmonary embolism may have a negative effect on the health status of COVID-19 patients. The study highlights the need to consider measures for reducing thromboembolism risk among COVID-19 patients.