What are the risk factors and effectiveness of prophylaxis for venous thromboembolism in COVID-19 patients?

Abstract

BACKGROUND: An emerging issue in the management of the novel COVID-19 coronavirus is morbidity and mortality associated with venous thrombolytic events. Apart from respiratory failure, coagulopathy is a common abnormality in patients with COVID‐19, with elevated levels of both fibrinogen and D‐dimer. For example, Oudkerk at al noted a number of case studies describing thrombolytic events in COVID-19 patients in their report, raising concerns about this issue. When considering management advice for patients with COVID-19 it is important to consider two factors. Firstly, what are the risk factors associated with thrombolytic events in COVID-19 patients? Secondly, what are the optimal strategies for prophylaxis and treatments for thrombolytic events in this patient groups? Understanding the current evidence for both risk factors and management strategies for venous thrombolytic events (VTE) in the these groups will aid clinical decision making. To contribute to this knowledge base, we conducted a rapid literature review using a systematic search method to identify relevant studies in relation to risk factors or managements of VTEs. METHODS: Studies included in this review were primary studies which assess risks and management of thrombolytic events in COVID-19 patients. The following search strategy was applied to Medline and EMBASE on 07/05/2020 with no limits. (“COVID-19” or COVID19 or COVID-19 or “coronavirus disease 2019” or “coronavirus disease-19” or “2019-nCoV disease” or “severe acute respiratory syndrome coronavirus 2” or “Wuhan coronavirus” or “COVID-19 virus” or “SARS-CoV-2” or “SARS2” or “2019-nCoV” or “2019 novel coronavirus” or “2019 novel coronavirus infection” AND (“D-dimer” or “coagulation parameter” or “venous thromboembolism” or “novel coronavirus pneumonia” or “blood coagulation” or “fibrin fibrinogen degradation products” or “vein thrombosis” or “thrombosis” or “lung embolism” or “PE” or “thromboembolism” or “venous thromboembolism” or “pulmonary embolism “).af. RESULTS: Included studies. The search returned 364 studied after duplicates were removed, of which 9 were included. Most of the studies which were included from France (4 studies) the other studies came from Italy (2 studies), China (1 study), the USA (1 study) and the Netherlands (1 study). Most studies were Retrospective case series, this includes Bozzani et al, Cui et al, Griffin et al, Klok et al, Leonard-Lorant et al, Llitjos et al, Poissy et al. There was one retrospective cohort study, Lodigiani et al, and one prospective cohort study, Helms et al [...]