Pulmonary Embolism Does Not Have an Unusually High Incidence Among Hospitalized COVID19 Patients
Introduction: Acute respiratory illnesses from COVID19 infection are increasing globally. Reports from earlier in the pandemic suggested that patients hospitalized for COVID19 are at particularly high risk for pulmonary embolism (PE). To estimate the incidences of PE during hospitalization for COVID...
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doaj-fc8d72a551234263934288bdfa2ea5c02021-03-13T03:33:29ZengSAGE PublishingClinical and Applied Thrombosis/Hemostasis1938-27232021-03-012710.1177/1076029621996471Pulmonary Embolism Does Not Have an Unusually High Incidence Among Hospitalized COVID19 PatientsNicolas Gallastegui MD0Jenny Y. Zhou MD1Annette von Drygalski MD, PharmD, RMSK2Richard F. W. Barnes PhD3Timothy M. Fernandes MD, MPH4Timothy A. Morris MD, FCCP5 University of California San Diego, Department of Medicine, Division of Hematology/Oncology, La Jolla CA, USA University of California San Diego, Department of Medicine, Division of Hematology/Oncology, La Jolla CA, USA The Scripps Research Institute, Department of Molecular Medicine, La Jolla, CA, USA University of California San Diego, Department of Medicine, Division of Hematology/Oncology, La Jolla CA, USA University of California San Diego, Department of Medicine, Division of Pulmonary and Critical Care Medicine, San Diego, CA, USA University of California San Diego, Department of Medicine, Division of Pulmonary and Critical Care Medicine, San Diego, CA, USAIntroduction: Acute respiratory illnesses from COVID19 infection are increasing globally. Reports from earlier in the pandemic suggested that patients hospitalized for COVID19 are at particularly high risk for pulmonary embolism (PE). To estimate the incidences of PE during hospitalization for COVID19, we performed a rigorous systematic review of published literature. Methods: We searched for case series, cohort studies and clinical trials from December 1, 2019 to July 13, 2020 that reported the incidence of PE among consecutive patients who were hospitalized for COVID19 in ICUs and in non-ICU hospital wards. To reflect the general population of hospitalized COVID19 patients, we excluded studies in which subject enrollment was linked to the clinical suspicion for venous thromboembolism (VTE). Results: Fifty-seven studies were included in the analysis. The combined random effects estimate of PE incidence among all hospitalized COVID19 patients was 7.1% (95% CI: 5.2%, 9.1%). Studies with larger sample sizes reported significantly lower PE incidences than smaller studies (r 2 = 0.161, p = 0.036). The PE incidence among studies that included 400 or more patients was 3.0% (95% CI: 1.7%, 4.6%). Among COVID19 patients admitted to ICUs, the combined estimated PE incidence was 13.7% (95% CI: 8.0%, 20.6%). The incidence of ICU-related PE also decreased as the study sample sizes increased. The single largest COVID19 ICU study (n = 2215) disclosed a PE incidence of 2.3% (95% CI: 1.7%, 3.0%). Conclusion: PE incidences among hospitalized COVID19 patients are much lower than has been previously postulated based on smaller, often biased study reports. The incidence of “microthrombosis,” leading to occlusion of microscopic blood vessels, remains unknown.https://doi.org/10.1177/1076029621996471 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Nicolas Gallastegui MD Jenny Y. Zhou MD Annette von Drygalski MD, PharmD, RMSK Richard F. W. Barnes PhD Timothy M. Fernandes MD, MPH Timothy A. Morris MD, FCCP |
spellingShingle |
Nicolas Gallastegui MD Jenny Y. Zhou MD Annette von Drygalski MD, PharmD, RMSK Richard F. W. Barnes PhD Timothy M. Fernandes MD, MPH Timothy A. Morris MD, FCCP Pulmonary Embolism Does Not Have an Unusually High Incidence Among Hospitalized COVID19 Patients Clinical and Applied Thrombosis/Hemostasis |
author_facet |
Nicolas Gallastegui MD Jenny Y. Zhou MD Annette von Drygalski MD, PharmD, RMSK Richard F. W. Barnes PhD Timothy M. Fernandes MD, MPH Timothy A. Morris MD, FCCP |
author_sort |
Nicolas Gallastegui MD |
title |
Pulmonary Embolism Does Not Have an Unusually High Incidence Among Hospitalized COVID19 Patients |
title_short |
Pulmonary Embolism Does Not Have an Unusually High Incidence Among Hospitalized COVID19 Patients |
title_full |
Pulmonary Embolism Does Not Have an Unusually High Incidence Among Hospitalized COVID19 Patients |
title_fullStr |
Pulmonary Embolism Does Not Have an Unusually High Incidence Among Hospitalized COVID19 Patients |
title_full_unstemmed |
Pulmonary Embolism Does Not Have an Unusually High Incidence Among Hospitalized COVID19 Patients |
title_sort |
pulmonary embolism does not have an unusually high incidence among hospitalized covid19 patients |
publisher |
SAGE Publishing |
series |
Clinical and Applied Thrombosis/Hemostasis |
issn |
1938-2723 |
publishDate |
2021-03-01 |
description |
Introduction: Acute respiratory illnesses from COVID19 infection are increasing globally. Reports from earlier in the pandemic suggested that patients hospitalized for COVID19 are at particularly high risk for pulmonary embolism (PE). To estimate the incidences of PE during hospitalization for COVID19, we performed a rigorous systematic review of published literature. Methods: We searched for case series, cohort studies and clinical trials from December 1, 2019 to July 13, 2020 that reported the incidence of PE among consecutive patients who were hospitalized for COVID19 in ICUs and in non-ICU hospital wards. To reflect the general population of hospitalized COVID19 patients, we excluded studies in which subject enrollment was linked to the clinical suspicion for venous thromboembolism (VTE). Results: Fifty-seven studies were included in the analysis. The combined random effects estimate of PE incidence among all hospitalized COVID19 patients was 7.1% (95% CI: 5.2%, 9.1%). Studies with larger sample sizes reported significantly lower PE incidences than smaller studies (r 2 = 0.161, p = 0.036). The PE incidence among studies that included 400 or more patients was 3.0% (95% CI: 1.7%, 4.6%). Among COVID19 patients admitted to ICUs, the combined estimated PE incidence was 13.7% (95% CI: 8.0%, 20.6%). The incidence of ICU-related PE also decreased as the study sample sizes increased. The single largest COVID19 ICU study (n = 2215) disclosed a PE incidence of 2.3% (95% CI: 1.7%, 3.0%). Conclusion: PE incidences among hospitalized COVID19 patients are much lower than has been previously postulated based on smaller, often biased study reports. The incidence of “microthrombosis,” leading to occlusion of microscopic blood vessels, remains unknown. |
url |
https://doi.org/10.1177/1076029621996471 |
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