Download PDF
CC BY 4.0 · TH Open 2022; 06(03): e276-e282
DOI: 10.1055/a-1913-4377
Original Article

Venous and Arterial Thrombosis in Ambulatory and Discharged COVID-19 Patients: A Systematic Review and Meta-analysis

Eman M. Mansory 
1   Department of Medicine, Division of Hematology, Western University, London, Ontario, Canada
2   Department of Hematology, King Abdulaziz University, Jeddah, Saudi Arabia
,
Mohammed Abu-Farhaneh
3   Department of Medicine, Western University, London, Ontario, Canada
,
Alla Iansavitchene
4   Health Sciences Library, London Health Sciences Centre, London, Ontario, Canada
,
Alejandro Lazo-Langner 
1   Department of Medicine, Division of Hematology, Western University, London, Ontario, Canada
5   Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Introduction Venous and arterial thromboses are frequently observed complications in patients with severe novel coronavirus disease 2019 (COVID-19) infection who require hospital admission. In this study, we evaluate the epidemiology of venous and arterial thrombosis events in ambulatory and postdischarge patients with COVID-19 infection.

Materials and Method EMBASE and MEDLINE were searched up to July 21, 2021, in addition to other sources. We included studies that assessed the epidemiology of venous and arterial thrombosis events in ambulatory and postdischarge COVID-19 patients.

Results A total of 16 studies (102,779 patients) were identified. The overall proportion of venous thromboembolic events in all patients, that is, ambulatory and postdischarge, was 0.80% (95% confidence interval [CI]: 0.44–1.28), 0.28% (95% CI: 0.07–0.64), and 1.16% (95% CI: 0.69–1.74), respectively. Arterial events occurred in 0.75% (95% CI: 0.27–1.47) of all patients, 1.45% (95% CI: 1.10–1.86) of postdischarge patients, and 0.23% (95% CI: 0.019–0.66) of ambulatory patients. The pooled incidence rate estimates per 1,000 patient-days for VTE events were 0.06 (95% CI: 0.03–0.08) and 0.12 (95% CI: 0.07–0.19) for outpatients and postdischarge, respectively, whereas for arterial events were 0.10 (95% CI: 0–0.30) and 0.26 (95% CI: 0.16–0.37).

Conclusion This study found a low risk of venous and arterial thrombi in ambulatory and postdischarge COVID-19 patients, with a higher risk in postdischarge patients compared with ambulatory patients. This suggests that regular universal thromboprophylaxis in these patient populations is probably not necessary.

Keywords

thrombosis - ambulatory - outpatients - postdischarge - COVID-19

Supplementary Material



Publication History

Received: 11 February 2022

Accepted: 25 July 2022

Accepted Manuscript online:
29 July 2022

Article published online:
19 September 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Salabei JK, Fishman TJ, Asnake ZT, Ali A, Iyer UG. COVID-19 Coagulopathy: Current knowledge and guidelines on anticoagulation. Heart Lung 2021; 50 (02) 357-360
    CrossrefPubMedGoogle Scholar
  • 2 Mansory EM, Srigunapalan S, Lazo-Langner A. Venous thromboembolism in hospitalized critical and noncritical COVID-19 patients: a systematic review and meta-analysis. TH Open 2021; 5 (03) e286-e294
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Nopp S, Moik F, Jilma B, Pabinger I, Ay C. Risk of venous thromboembolism in patients with COVID-19: A systematic review and meta-analysis. Res Pract Thromb Haemost 2020; 4 (07) 1178-1191
    CrossrefPubMedGoogle Scholar
  • 4 Malas MB, Naazie IN, Elsayed N, Mathlouthi A, Marmor R, Clary B. Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis. EClinicalMedicine 2020; 29: 100639
    CrossrefPubMedGoogle Scholar
  • 5 Wells GA, Shea B, O'Connell D. et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Accessed August 16, 2022 at: https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
    Google Scholar
  • 6 Jadad AR, Moore RA, Carroll D. et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials 1996; 17 (01) 1-12
    Google Scholar
  • 7 Lane PW. Meta-analysis of incidence of rare events. Stat Methods Med Res 2013; 22 (02) 117-132
    CrossrefPubMedGoogle Scholar
  • 8 Leijte WT, Wagemaker NMM, van Kraaij TDA. et al. Mortality and re-admission after hospitalization with COVID-19 [in Dutch]. Ned Tijdschr Geneeskd 2020; 164 (49) D5423
    PubMedGoogle Scholar
  • 9 Engelen MM, Vandenbriele C, Balthazar T. et al. Venous thromboembolism in patients discharged after COVID-19 hospitalization. Semin Thromb Hemost 2021; 47 (04) 362-371
    Google Scholar
  • 10 Giannis D, Allen SL, Tsang J. et al. Postdischarge thromboembolic outcomes and mortality of hospitalized patients with COVID-19: the CORE-19 registry. Blood 2021; 137 (20) 2838-2847
    CrossrefPubMedGoogle Scholar
  • 11 Spyropoulos AC, Ageno W, Albers GW. et al; MARINER Investigators. Rivaroxaban for thromboprophylaxis after hospitalization for medical illness. N Engl J Med 2018; 379 (12) 1118-1127
    CrossrefPubMedGoogle Scholar
  • 12 White RH, Romano PS, Zhou H, Rodrigo J, Bargar W. Incidence and time course of thromboembolic outcomes following total hip or knee arthroplasty. Arch Intern Med 1998; 158 (14) 1525-1531
    CrossrefPubMedGoogle Scholar
  • 13 Klemen ND, Feingold PL, Hashimoto B. et al. Mortality risk associated with venous thromboembolism: a systematic review and Bayesian meta-analysis. Lancet Haematol 2020; 7 (08) e583-e593
    CrossrefPubMedGoogle Scholar
  • 14 Zuin M, Engelen MM, Barco S. et al. Incidence of venous thromboembolic events in COVID-19 patients after hospital discharge: a systematic review and meta-analysis. Thromb Res 2022; 209: 94-98
    CrossrefPubMedGoogle Scholar
  • 15 Pasha AK, McBane RD, Chaudhary R. et al. Timing of venous thromboembolism diagnosis in hospitalized and non-hospitalized patients with COVID-19. Thromb Res 2021; 207: 150-157
    Google Scholar
  • 16 Roubinian NH, Dusendang JR, Mark DG. et al. Incidence of 30-Day venous thromboembolism in adults tested for SARS-CoV-2 infection in an integrated health care system in Northern California. JAMA Intern Med 2021; 181 (07) 997-1000
    CrossrefPubMedGoogle Scholar
  • 17 Roberts LN, Whyte MB, Georgiou L. et al. Postdischarge venous thromboembolism following hospital admission with COVID-19. Blood 2020; 136 (11) 1347-1350
    CrossrefPubMedGoogle Scholar
  • 18 Lund LC, Hallas J, Nielsen H. et al. Post-acute effects of SARS-CoV-2 infection in individuals not requiring hospital admission: a Danish population-based cohort study. Lancet Infect Dis 2021; 21 (10) 1373-1382
    CrossrefPubMedGoogle Scholar
  • 19 Connors JM, Brooks MM, Sciurba FC. et al; ACTIV-4B Investigators. Effect of antithrombotic therapy on clinical outcomes in outpatients with clinically stable symptomatic COVID-19: the ACTIV-4B randomized clinical trial. JAMA 2021; 326 (17) 1703-1712
    CrossrefPubMedGoogle Scholar
  • 20 Hozayen SM, Zychowski D, Benson S. et al. Outpatient and inpatient anticoagulation therapy and the risk for hospital admission and death among COVID-19 patients. EClinicalMedicine 2021; 41: 101139
    CrossrefPubMedGoogle Scholar
  • 21 Tan BK, Mainbourg S, Friggeri A. et al. Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis. Thorax 2021; 76 (10) 970-979
    CrossrefPubMedGoogle Scholar
  • 22 Perry TW, Pugh MJV, Waterer GW. et al. Incidence of cardiovascular events after hospital admission for pneumonia. Am J Med 2011; 124 (03) 244-251
    CrossrefPubMedGoogle Scholar
  • 23 Lang J, Yang N, Deng J. et al. Inhibition of SARS pseudovirus cell entry by lactoferrin binding to heparan sulfate proteoglycans. PLoS One 2011; 6 (08) e23710
    CrossrefPubMedGoogle Scholar
  • 24 Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020; 18 (05) 1094-1099
    CrossrefPubMedGoogle Scholar
  • 25 Barco S, Bingisser R, Colucci G. et al. Enoxaparin for primary thromboprophylaxis in ambulatory patients with coronavirus disease-2019 (the OVID study): a structured summary of a study protocol for a randomized controlled trial. Trials 2020; 21 (01) 770
    CrossrefPubMedGoogle Scholar
  • 26 Ramacciotti E, Barile Agati L, Calderaro D. et al; MICHELLE investigators. Rivaroxaban versus no anticoagulation for post-discharge thromboprophylaxis after hospitalisation for COVID-19 (MICHELLE): an open-label, multicentre, randomised, controlled trial. Lancet 2022; 399 (10319): 50-59
    CrossrefPubMedGoogle Scholar
  • 27 Schünemann HJ, Cushman M, Burnett AE. et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv 2018; 2 (22) 3198-3225
    CrossrefPubMedGoogle Scholar
  • 28 Cuker A, Tseng EK, Nieuwlaat R. et al. American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: July 2021 update on postdischarge thromboprophylaxis. Blood Adv 2022; 6 (02) 664-671
    CrossrefPubMedGoogle Scholar
  • 29 Moores LK, Tritschler T, Brosnahan S. et al. Prevention, diagnosis, and treatment of VTE in patients with coronavirus disease 2019: CHEST Guideline and Expert Panel Report. Chest 2020; 158 (03) 1143-1163
    CrossrefPubMedGoogle Scholar
  • 30 Tanislav C, Rosenbauer J, Zingel R, Kostev K. No increased incidence of venous thrombosis or pulmonary embolism after SARS-CoV-2 vaccination in Germany. Public Health 2022; 207: 14-18
    Google Scholar
  • 31 Houghton DE, Wysokinski W, Casanegra AI. et al. Risk of venous thromboembolism after COVID-19 vaccination. J Thromb Haemost 2022; 20 (07) 1638-1644
    Google Scholar
  • 32 Andrews NJ, Stowe J, Ramsay ME, Miller E. Risk of venous thrombotic events and thrombocytopenia in sequential time periods after ChAdOx1 and BNT162b2 COVID-19 vaccines: A national cohort study in England. Lancet Reg Health Eur 2022; 13: 100260
    CrossrefPubMedGoogle Scholar