Risk Factors for Venous Thromboembolism in Severe COVID-19: A Study-Level Meta-Analysis of 21 Studies

Hervé Lobbes, Sabine Mainbourg, Vicky Mai, Marion Douplat, Steeve Provencher and Jean-Christophe Lega
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Hervé Lobbes: Service de Médecine Interne, Hôpital Estaing, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
Sabine Mainbourg: Service de Médecine Interne et Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France
Vicky Mai: Pulmonary Hypertension Research Group, Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec, QC G1V 4G5, Canada
Marion Douplat: Service d’Accueil des Urgences, Hospices Civils de Lyon, Hôpital Lyon-Sud, 69310 Pierre-Bénite, France
Steeve Provencher: Pulmonary Hypertension Research Group, Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec, QC G1V 4G5, Canada
Jean-Christophe Lega: Service de Médecine Interne et Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France

IJERPH, 2021, vol. 18, issue 24, 1-17

Abstract: Venous thromboembolism (VTE) in patients with COVID-19 in intensive care units (ICU) is frequent, but risk factors (RF) remain unidentified. In this meta-analysis (CRD42020188764) we searched for observational studies from ICUs reporting the association between VTE and RF in Medline/Embase up to 15 April 2021. Reviewers independently extracted data in duplicate and assessed the certainty of the evidence using the GRADE approach. Analyses were conducted using the random-effects model and produced a non-adjusted odds ratio (OR). We analysed 83 RF from 21 studies (5296 patients). We found moderate-certainty evidence for an association between VTE and the D-dimer peak (OR 5.83, 95%CI 3.18–10.70), and length of hospitalization (OR 7.09, 95%CI 3.41–14.73) and intubation (OR 2.61, 95%CI 1.94–3.51). We identified low-certainty evidence for an association between VTE and CRP (OR 1.83, 95% CI 1.32–2.53), D-dimer (OR 4.58, 95% CI 2.52–8.50), troponin T (OR 8.64, 95% CI 3.25–22.97), and the requirement for inotropic drugs (OR 1.67, 95% CI 1.15–2.43). Traditional VTE RF (i.e., history of cancer, previous VTE events, obesity) were not found to be associated to VTE in COVID-19. Anticoagulation was not associated with a decreased VTE risk. VTE RF in severe COVID-19 correspond to individual illness severity, and inflammatory and coagulation parameters.

Keywords: COVID-19; critical care; meta-analysis; risk factors; venous thromboembolism (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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