Differences between surviving and non-surviving venous thromboembolism COVID-19 patients: a systematic review

Thrombosis Journal

Jathniel Panneflek¹  Mario Alejandro Fabiani²  Yoezer Z Flores-Sayavedra³  Abigail Montserrat Molina-Rodriguez³  Hector Betancourt-del Campo³  Ray Erick Ramos-Cazares³  Jose Alfredo Salinas-Casanova³  Alejandra Castro-Varela³  Jaime Alberto Guajardo-Lozano³  Hector Lopez-de la Garza³  Arturo Adrián Martinez-Ibarra³  Daniela Martinez-Magallanes³  Mauricio Castillo-Perez³  Eduardo Vazquez-Garza⁴  Carlos Jerjes-Sanchez⁵  Jose Gildardo Paredes-Vazquez⁶ 

[1] Centro de Investigacion Biomedica del Hospital Zambrano Hellion, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico;Instituto de Cardiologia y Medicina Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Batallón San Patricio 112, Real de San Agustin, 66278, San Pedro Garza Garcia, Nuevo Leon, Mexico;Tecnologico de Monterrey. Escuela de Medicina y Ciencias de la Salud., San Pedro Garza Garcia, Nuevo Leon, Mexico;Tecnologico de Monterrey. Escuela de Medicina y Ciencias de la Salud., San Pedro Garza Garcia, Nuevo Leon, Mexico;Centro de Investigacion Biomedica del Hospital Zambrano Hellion, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico;Tecnologico de Monterrey. Escuela de Medicina y Ciencias de la Salud., San Pedro Garza Garcia, Nuevo Leon, Mexico;Centro de Investigacion Biomedica del Hospital Zambrano Hellion, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico;Instituto de Cardiologia y Medicina Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Batallón San Patricio 112, Real de San Agustin, 66278, San Pedro Garza Garcia, Nuevo Leon, Mexico;Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Av. Ignacio Morones Prieto 3000, CP, 64718, Monterrey, N.L., Mexico;Tecnologico de Monterrey. Escuela de Medicina y Ciencias de la Salud., San Pedro Garza Garcia, Nuevo Leon, Mexico;Instituto de Cardiologia y Medicina Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Batallón San Patricio 112, Real de San Agustin, 66278, San Pedro Garza Garcia, Nuevo Leon, Mexico;

关键词: SARS-CoV-2;    COVID-19;    Venous thromboembolism;    Pulmonary embolism;    Deep vein thrombosis;    Thrombolysis;    Anticoagulation;   

DOI  :  10.1186/s12959-021-00346-y

来源: Springer

【 摘 要 】

BackgroundTo our knowledge, the treatment, outcome, clinical presentation, risk stratification of patients with venous thromboembolism and COVID-19 have not been well characterized.MethodsWe searched for systematic reviews, cohorts, case series, case reports, editor letters, and venous thromboembolism COVID-19 patients’ abstracts following PRISMA and PROSPERO statements. We analyzed therapeutic approaches and clinical outcomes of venous thromboembolism COVID-19 patients. Inclusion: COVID-19 patients with venous thromboembolism confirmed by an imaging method (venous doppler ultrasound, ventilation-perfusion lung scan, computed tomography pulmonary angiogram, pulmonary angiography). We assessed and reported the original Pulmonary Embolism Severity Index for each pulmonary embolism patient. In addition, we defined major bleedings according to the International Society of Thrombosis and Haemostasis criteria.ResultsWe performed a systematic review from August 9 to August 30, 2020. We collected 1,535 papers from PubMed, Scopus, Web of Science, Wiley, and Opengrey. We extracted data from 89 studies that describe 143 patients. Unfractionated and low-molecular-weight heparin was used as parenteral anticoagulation in 85/143 (59%) cases. The Food and Drug Administration-approved alteplase regimen guided the advanced treatment in 39/143 (27%) patients. The mortality was high (21.6%, CI 95% 15.2-29.3). The incidence of major bleeding complications was 1 (0.9%) in the survival group and 1 (3.2%) in the death group. Pulmonary Embolism Severity Index was class I in 11.6% and II in 22.3% in survivors compared to 0% and 6.5% in non-survivors, respectively. Patients who experienced venous thromboembolism events at home were more likely to live than in-hospital events.ConclusionsWe determined a high mortality incidence of pulmonary embolism and a low rate of bleeding. Unfractionated and low-molecular-weight heparin drove parenteral anticoagulation and alteplase the advanced treatment in both groups. The original Pulmonary Embolism Severity Index could be helpful in the risk stratification.

【 授权许可】

CC BY