COVID and venous thrombosis: systematic review of literature

Daniela Mazzaccaro, Matteo Giannetta, Fabiana Fancoli, Valentina Milani, Alfredo Modafferi, Giovanni Malacrida, Paolo Righini, Massimiliano M. Marrocco-Trischitta, Giovanni Nano


Introduction: We aimed to review the prevalence, the risk factors and the outcomes of venous thrombosis (VT) in patients hospitalized for COronaVirus Disease 19 (COVID-19).

Evidence Acquisition: Electronic bibliographic databases were searched using the words “COVID venous thrombosis”. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards.

Evidence Synthesis: The search of the literature retrieved 877 results. After assessment of full texts, 69 papers were included in the qualitative analysis and 23 of them in the quantitative evaluation. The analyzed studies included a total of 106,838 patients hospitalized for COVID-19 from January to December 2020. The pooled reported prevalence rate of VT was in median 16.7% (IQR 5.8-30%), being higher in ICU patients (60.8-85.4%). VT events were reported in about 75% of cases in the popliteal and calf veins. Signs and symptoms were present in 6.1% of cases. At quantitative evaluation, older age, D-dimer and obesity increased the odds to experience a VT (OR=3.54, 95% CI 0.65-6.43, P=0.01; OR=956.86, 95% CI 225.67-1668.05, P=0.01; OR=1.42, 95% CI 1.01-1.99, P=0.03 respectively). Female sex seemed to be protective against the odds of VT (OR=0.77, 95% CI 0.63-0.93, P=0.007).

Conclusions: Among patients hospitalized for COVID-19, VT is a relatively common finding, with higher prevalence rates in ICU patients. VT occurs mostly in the distal regions of the lower limb and is asymptomatic in most cases. Older age, obesity and higher D-dimer values on admission increased the odds of VT, while female sex was protective against the odds of VT.

Key words: COVID-19; Venous thrombosis; SARS-CoV-2

The Journal of Cardiovascular Surgery 2021 December;62(6):548-57
DOI: 10.23736/S0021-9509.21.12022-1