COVID‐19 (SARS‐CoV‐2) infection and thrombotic conditions: A systematic review and meta‐analysis

Gabbai‐Armelin, Paulo Roberto; de Oliveira, Analú Barros; Ferrisse, Túlio Morandin; Sales, Luciana Solera; Barbosa, Elis Rodrigues Oliveira; Miranda, Marina Lins; Salomão, Karina Borges; Brighenti, Fernanda Lourenção

BACKGROUND: COVID‐19 is an infectious disease caused by SARS‐CoV‐2 associated with haematological manifestations (thrombolytic events). AIMS: Considering the high prevalence of the thrombotic scenarios associated with COVID‐19, the aim of this study was to perform a systematic review of the available literature, concerning the relation of COVID‐19 and the thrombotic events, and identify prognostic factors for these events. MATERIALS & METHODS: PubMed, Web of Science and Scopus databases were searched. Independent reviewers conducted all flow diagram steps. For qualitative analysis, Oxford level of evidence and Newcastle‐Ottawa scale were used in the eligible articles. For the prognostic factors, a meta‐analysis was conducted to age, number of neutrophils and platelets, and levels of ferritin, C‐reactive protein, lactate dehydrogenase and D‐dimer. Publication bias was accessed by funnel plot and by trim‐and‐fill test. Trim‐and‐fill test was also applied to evaluate meta‐analysis bias. RESULTS: Twenty articles were included in the qualitative analysis, and 6 articles were included in the meta‐analysis. Case‐control studies showed bias related to exposure, and the main bias in cohort studies were related to selection and outcome. All articles received score 4 for the level of evidence. Hypertension and diabetes were the comorbidities more frequently associated with thrombolytic events. Significant results were found regarding D‐dimer (P < .0001) and age (P = .0202) for thrombotic events in patients diagnosed with COVID‐19. CONCLUSION: Patients older than 60 years, with hypertension, diabetes and D‐Dimer values above 3.17 µg/mL, can be considered prognostic factors for developing thrombotic events due to COVID‐19.