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      Risk of venous thromboembolism in patients with COVID‐19: A systematic review and meta‐analysis

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          Abstract

          Background

          Venous thromboembolism (VTE) is frequently observed in patients with coronavirus disease 2019 (COVID‐19). However, reported VTE‐rates differ substantially.

          Objectives

          We aimed at evaluating available data and estimating the prevalence of VTE in COVID‐19 patients.

          Methods

          We conducted a systematic literature search (MEDLINE, EMBASE, WHO COVID‐19 database) to identify studies reporting VTE‐rates in COVID‐19 patients. Studies with suspected high risk of bias were excluded from quantitative synthesis. Pooled outcome rates were obtained within a random effects meta‐analysis. Subgroup analyses were performed for different settings (intensive care unit (ICU) vs. non‐ICU hospitalization and screening vs. no screening) and the association of D‐dimer levels and VTE‐risk was explored.

          Results

          Eighty‐six studies (33,970 patients) were identified and 66 (28,173 patients, mean age: 62.6 years, 60% men, 20% ICU‐patients) were included in quantitative analysis. The overall VTE‐prevalence estimate was 14.1% (95%CI 11.6‐16.9), 40.3% (95%CI 27.0‐54.3) with ultrasound‐screening and 9.5% (95%CI 7.5‐11.7) without screening. Subgroup analysis revealed high heterogeneity, with a VTE‐prevalence of 7.9% (95%CI 5.1‐11.2) in non‐ICU and 22.7% (95%CI 18.1‐27.6) in ICU patients. Prevalence of pulmonary embolism (PE) in non‐ICU and ICU patients was 3.5% (95%CI 2.2‐5.1) and 13.7% (95%CI 10.0‐17.9). Patients developing VTE had higher D‐dimer levels (weighted mean difference 3.26 µg/ml (95%CI 2.76‐3.77) than non‐VTE patients.

          Conclusion

          VTE occurs in 22.7% of patients with COVID‐19 in the ICU, but VTE risk is also increased in non‐ICU hospitalized patients. Patients developing VTE had higher D‐dimer levels. Studies evaluating thromboprophylaxis strategies in patients with COVID‐19 are needed to improve prevention of VTE.

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          Author and article information

          Contributors
          cihan.ay@meduniwien.ac.at
          Journal
          Res Pract Thromb Haemost
          Res Pract Thromb Haemost
          10.1002/(ISSN)2475-0379
          RTH2
          Research and Practice in Thrombosis and Haemostasis
          John Wiley and Sons Inc. (Hoboken )
          2475-0379
          25 September 2020
          : 10.1002/rth2.12439
          Affiliations
          [ 1 ] Clinical Division of Haematology and Haemostaseology Department of Medicine I Medical University of Vienna Vienna Austria
          [ 2 ] Department of Clinical Pharmacology Medical University of Vienna Vienna Austria
          [ 3 ] I.M. Sechenov First Moscow State Medical University (Sechenov University) Moscow Russia
          Author notes
          [*] [* ] Corresponding author: Cihan Ay, MD

          Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria, Waehringer Guertel 18‐20, A‐1090 Vienna, Austria

          e‐mail: cihan.ay@ 123456meduniwien.ac.at

          [†]

          These authors contributed equally to this work.

          Author information
          https://orcid.org/0000-0001-5652-7977
          https://orcid.org/0000-0003-2607-9717
          Article
          RTH212439
          10.1002/rth2.12439
          7537137
          33043231
          c4a97ee1-3785-4b99-aa9f-0401f63214de
          This article is protected by copyright. All rights reserved.

          This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

          History
          Page count
          Figures: 0, Tables: 0, Pages: 42, Words: 388
          Categories
          Original Article
          Original Articles
          Custom metadata
          2.0
          accepted-manuscript
          Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.2 mode:remove_FC converted:06.10.2020

          covid‐19,prevalence,pulmonary embolism,severe acute respiratory syndrome coronavirus 2,venous thromboembolism

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