Abstract
Coronavirus disease 2019 (COVID-19) may have a wide spectrum of clinical presentations,
leading in some cases to a critical condition with poor long-term outcomes and residual
disability requiring post-acute rehabilitation. A major concern in severe COVID-19
is represented by a concomitant prothrombotic state. However, contrasting data are
available about the prevalence of venous thromboembolism (VTE), including deep vein
thrombosis (DVT) and/or pulmonary embolism (PE). A detailed search on the association
of COVID-19 with thromboembolic complications was conducted in the main electronic
databases (PubMed, Web of Science, and Scopus) according to the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The weighted mean
prevalence (WMP) with 95% confidence interval (95% CI) was calculated with the random-effects
model. Twenty studies enrolling 1,988 COVID-19 patients were included. The WMP of
VTE was 31.3% (95% CI: 24.3–39.2%). The WMP of DVT was 19.8% (95% CI: 10.5–34.0%),
whereas the WMP of PE was 18.9% (95% CI: 14.4–24.3%). Similar results were obtained
when specifically analyzing studies on patients admitted to intensive care units and
those on patients under antithrombotic prophylaxis. Regression models showed that
an increasing age was associated with a higher prevalence of VTE (Z-score: 3.11, p = 0.001), DVT (Z-score: 2.33, p = 0.002), and PE (Z-score: 3.03, p = 0.002), while an increasing body mass index was associated with an increasing prevalence
of PE (Z-score = 2.01, p = 0.04). Male sex did not impact the evaluated outcomes. The rate of thromboembolic
complications in COVID-19 patients is definitely high. Considering the risk of fatal
and disabling complications, adequate screening procedures and antithrombotic strategies
should be implemented.
Keywords
SARS-CoV-2 - COVID-19 - thrombosis - disability - anticoagulants
