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Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis | Thorax
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No commercial re-use. See rights and permissions. Published by BMJ.. This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.https://bmj.com/coronavirus/usage" /> <meta name="DC.AccessRights" content="restricted" /> <meta name="DC.Relation" content="10.1136/thoraxjnl-2021-218144" /> <meta name="DC.Description" content="Background The prevalence of venous thromboembolic event (VTE) and arterial thromboembolic event (ATE) thromboembolic events in patients with COVID-19 remains largely unknown. Methods In this meta-analysis, we systematically searched for observational studies describing the prevalence of VTE and ATE in COVID-19 up to 30 September 2020. Results We analysed findings from 102 studies (64 503 patients). The frequency of COVID-19-related VTE was 14.7% (95% CI 12.1% to 17.6%, I2=94%; 56 studies; 16 507 patients). The overall prevalence rates of pulmonary embolism (PE) and leg deep vein thrombosis were 7.8% (95% CI 6.2% to 9.4%, I2=94%; 66 studies; 23 117 patients) and 11.2% (95% CI 8.4% to 14.3%, I2=95%; 48 studies; 13 824 patients), respectively. Few were isolated subsegmental PE. The VTE prevalence was significantly higher in intensive care unit (ICU) (23.2%, 95% CI 17.5% to 29.6%, I2=92%, vs 9.0%, 95% CI 6.9% to 11.4%, I2=95%; pinteraction<0.0001) and in series systematically screening patients compared with series testing symptomatic patients (25.2% vs 12.7%, pinteraction=0.04). The frequency rates of overall ATE, acute coronary syndrome, stroke and other ATE were 3.9% (95% CI 2.0% to to 3.0%, I2=96%; 16 studies; 7939 patients), 1.6% (95% CI 1.0% to 2.2%, I2=93%; 27 studies; 40 597 patients) and 0.9% (95% CI 0.5% to 1.5%, I2=84%; 17 studies; 20 139 patients), respectively. Metaregression and subgroup analyses failed to explain heterogeneity of overall ATE. High heterogeneity limited the value of estimates. Conclusions Patients admitted in the ICU for severe COVID-19 had a high risk of VTE. Conversely, further studies are needed to determine the specific effects of COVID-19 on the risk of ATE or VTE in less severe forms of the disease. All data relevant to the study are included in the article or uploaded as supplementary information. Data have been provided in the figures and tables." /> <meta name="DC.Contributor" content="Boun Kim Tan" /> <meta name="DC.Contributor" content="Sabine Mainbourg" /> <meta name="DC.Contributor" content="Arnaud Friggeri" /> <meta name="DC.Contributor" content="Laurent Bertoletti" /> <meta name="DC.Contributor" content="Marion Douplat" /> <meta name="DC.Contributor" content="Yesim Dargaud" /> <meta name="DC.Contributor" content="Claire Grange" /> <meta name="DC.Contributor" content="Hervé Lobbes" /> <meta name="DC.Contributor" content="Steeve Provencher" /> <meta name="DC.Contributor" content="Jean-Christophe Lega" /> <meta name="article:published_time" content="2021-10-01" /> <meta name="article:section" content="Critical care" /> <meta name="citation_title" content="Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis" /> <meta name="citation_abstract" lang="en" content="<h3>Background</h3> <p>The prevalence of venous thromboembolic event (VTE) and arterial thromboembolic event (ATE) thromboembolic events in patients with COVID-19 remains largely unknown.</p><h3>Methods</h3> <p>In this meta-analysis, we systematically searched for observational studies describing the prevalence of VTE and ATE in COVID-19 up to 30 September 2020.</p><h3>Results</h3> <p>We analysed findings from 102 studies (64 503 patients). The frequency of COVID-19-related VTE was 14.7% (95% CI 12.1% to 17.6%, I<sup>2</sup>=94%; 56 studies; 16 507 patients). The overall prevalence rates of pulmonary embolism (PE) and leg deep vein thrombosis were 7.8% (95% CI 6.2% to 9.4%, I<sup>2</sup>=94%; 66 studies; 23 117 patients) and 11.2% (95% CI 8.4% to 14.3%, I<sup>2</sup>=95%; 48 studies; 13 824 patients), respectively. Few were isolated subsegmental PE. The VTE prevalence was significantly higher in intensive care unit (ICU) (23.2%, 95% CI 17.5% to 29.6%, I<sup>2</sup>=92%, vs 9.0%, 95% CI 6.9% to 11.4%, I<sup>2</sup>=95%; p<sub>interaction</sub>&lt;0.0001) and in series systematically screening patients compared with series testing symptomatic patients (25.2% vs 12.7%, p<sub>interaction</sub>=0.04). The frequency rates of overall ATE, acute coronary syndrome, stroke and other ATE were 3.9% (95% CI 2.0% to to 3.0%, I<sup>2</sup>=96%; 16 studies; 7939 patients), 1.6% (95% CI 1.0% to 2.2%, I<sup>2</sup>=93%; 27 studies; 40 597 patients) and 0.9% (95% CI 0.5% to 1.5%, I<sup>2</sup>=84%; 17 studies; 20 139 patients), respectively. Metaregression and subgroup analyses failed to explain heterogeneity of overall ATE. High heterogeneity limited the value of estimates.</p><h3>Conclusions</h3> <p>Patients admitted in the ICU for severe COVID-19 had a high risk of VTE. Conversely, further studies are needed to determine the specific effects of COVID-19 on the risk of ATE or VTE in less severe forms of the disease.</p>" /> <meta name="citation_journal_title" content="Thorax" /> <meta name="citation_publisher" content="BMJ Publishing Group Ltd" /> <meta name="citation_publication_date" content="2021/10/01" /> <meta name="citation_mjid" content="thoraxjnl;76/10/970" /> <meta name="citation_id" content="76/10/970" /> <meta name="citation_public_url" content="https://thorax.bmj.com/content/76/10/970" /> <meta name="citation_abstract_html_url" content="https://thorax.bmj.com/content/76/10/970.abstract" /> <meta name="citation_full_html_url" content="https://thorax.bmj.com/content/76/10/970.full" /> <meta name="citation_pdf_url" content="https://thorax.bmj.com/content/thoraxjnl/76/10/970.full.pdf" /> <meta name="citation_issn" content="0040-6376" /> <meta name="citation_issn" content="1468-3296" /> <meta name="citation_doi" content="10.1136/thoraxjnl-2020-215383" /> <meta name="citation_pmid" content="33622981" /> <meta name="citation_volume" content="76" /> <meta name="citation_issue" content="10" /> <meta name="citation_article_type" content="Research Article" /> <meta name="citation_section" content="Critical care" /> <meta name="citation_firstpage" content="970" /> <meta name="citation_lastpage" content="979" /> <meta name="citation_author" content="Boun Kim Tan" /> <meta name="citation_author_institution" content="Department of Intensive Care Unit" /> <meta name="citation_author_institution" content="Hôpital Lyon Sud, Hospices Civils de Lyon" /> <meta name="citation_author" content="Sabine Mainbourg" /> <meta name="citation_author_institution" content="Department of Internal and Vascular Medecine" /> <meta name="citation_author_institution" content="Hôpital Lyon Sud, Hospices Civils de Lyon" /> <meta name="citation_author_institution" content="Equipe Evaluation et Modélisation des Effets Thérapeutiques, UMR - CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive" /> <meta name="citation_author_institution" content="Claude Bernard University Lyon 1" /> <meta name="citation_author" content="Arnaud Friggeri" /> <meta name="citation_author_institution" content="Department of Intensive Care Unit" /> <meta name="citation_author_institution" content="Hôpital Lyon Sud, Hospices Civils de Lyon" /> <meta name="citation_author" content="Laurent Bertoletti" /> <meta name="citation_author_institution" content="Service de Médecine Vasculaire et Thérapeutique" /> <meta name="citation_author_institution" content="CHU de Saint-Étienne" /> <meta name="citation_author_institution" content="Université Jean-Monnet, UMR 1059, SAINBIOSE; INSERM CIC 1408" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0001-8214-3010" /> <meta name="citation_author" content="Marion Douplat" /> <meta name="citation_author_institution" content="Service d'accueil des urgences" /> <meta name="citation_author_institution" content="Hôpital Lyon Sud, Hospices Civils de Lyon" /> <meta name="citation_author" content="Yesim Dargaud" /> <meta name="citation_author_institution" content="Groupe d’Etude Multidisciplinaire des Maladies Thrombotiques" /> <meta name="citation_author_institution" content="Hospices Civils de Lyon" /> <meta name="citation_author_institution" content="Unité d'Hémostase Clinique" /> <meta name="citation_author_institution" content="Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon" /> <meta name="citation_author" content="Claire Grange" /> <meta name="citation_author_institution" content="Department of Internal and Vascular Medecine" /> <meta name="citation_author_institution" content="Hôpital Lyon Sud, Hospices Civils de Lyon" /> <meta name="citation_author" content="Hervé Lobbes" /> <meta name="citation_author_institution" content="Department of Internal and Vascular Medecine" /> <meta name="citation_author_institution" content="Hôpital Lyon Sud, Hospices Civils de Lyon" /> <meta name="citation_author_institution" content="Department of Internal Medicine" /> <meta name="citation_author_institution" content="CHU de Clermont-Ferrand" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0002-8511-8432" /> <meta name="citation_author" content="Steeve Provencher" /> <meta name="citation_author_institution" content="Pulmonary Hypertension Research Group" /> <meta name="citation_author_institution" content="Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University" /> <meta name="citation_author" content="Jean-Christophe Lega" /> <meta name="citation_author_institution" content="Department of Internal and Vascular Medecine" /> <meta name="citation_author_institution" content="Hôpital Lyon Sud, Hospices Civils de Lyon" /> <meta name="citation_author_institution" content="Equipe Evaluation et Modélisation des Effets Thérapeutiques, UMR - CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive" /> <meta name="citation_author_institution" content="Claude Bernard University Lyon 1" /> <meta name="citation_author_institution" content="Groupe d’Etude Multidisciplinaire des Maladies Thrombotiques" /> <meta name="citation_author_institution" content="Hospices Civils de Lyon" /> <meta name="citation_author_orcid" content="http://orcid.org/0000-0002-9398-2968" /> <meta name="citation_reference" content="citation_journal_title=PLoS Med;citation_title=The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration;citation_volume=6;citation_year=2009" /> <meta name="citation_reference" content="citation_journal_title=BMC Med Res Methodol;citation_title=Consensus-Based recommendations for investigating clinical heterogeneity in systematic reviews;citation_volume=13;citation_year=2013" /> <meta name="citation_reference" content="citation_journal_title=Intern Emerg Med;citation_title=Prevalence of asymptomatic deep vein thrombosis in patients hospitalized with SARS-CoV-2 pneumonia: a cross-sectional study;citation_year=2020" /> <meta name="citation_reference" content="citation_journal_title=Br J Haematol;citation_title=Prevalence of venous thromboembolism in critically ill patients with COVID‐19;citation_volume=190;citation_year=2020" /> <meta name="citation_reference" content="citation_journal_title=Crit Care Resusc;citation_title=Characteristics, treatment, outcomes and cause of death of invasively ventilated patients with COVID-19 ARDS in Milan, Italy;citation_year=2020" /> <meta name="citation_reference" content="citation_journal_title=Respir Med;citation_title=Pulmonary artery thrombi are co-located with opacifications in SARS-CoV2 induced ARDS;citation_volume=172;citation_year=2020" /> <meta name="citation_reference" content="citation_journal_title=Crit Care Explor;citation_title=Factors associated with pulmonary embolism among coronavirus disease 2019 acute respiratory distress syndrome: a multicenter study among 375 patients;citation_volume=2;citation_year=2020" /> <meta name="citation_reference" content="citation_journal_title=J Clin Ultrasound;citation_title=Applicability of bedside ultrasonography for the diagnosis of deep venous thrombosis in patients with COVID‐19 and treatment with low molecular weight heparin;citation_year=2020" /> <meta name="citation_reference" content="citation_journal_title=JAMA Netw Open;citation_title=Venous thrombosis among critically ill patients with coronavirus disease 2019 (COVID-19);citation_volume=3;citation_year=2020" /> <meta name="citation_reference" content="citation_journal_title=J Am Coll Cardiol;citation_author=S. Voicu;citation_author=P. Bonnin;citation_author=A. Stépanian;citation_title=High prevalence of deep vein thrombosis in mechanically ventilated COVID-19 patients;citation_volume=76;citation_year=2020;citation_pmid=http://www.ncbi.nlm.nih.gov/pubmed/32479784;citation_doi=10.1016/j.jacc.2020.05.053" /> <meta name="citation_reference" content="citation_journal_title=Crit Care;citation_title=Lung ultrasound findings in patients with COVID-19 pneumonia;citation_volume=24;citation_year=2020" /> <meta name="citation_reference" content="citation_journal_title=JAMA Neurol;citation_title=Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China;citation_volume=77;citation_year=2020" /> <meta name="citation_reference" content="citation_title=Clinical pathology of critical patient with novel coronavirus pneumonia (COVID-19);citation_year=2020" /> <meta name="citation_reference" content="citation_journal_title=J Am Coll Cardiol;citation_author=I. Paranjpe;citation_author=V. Fuster;citation_author=A. Lala;citation_title=Association of treatment dose anticoagulation with in-hospital survival among hospitalized patients with COVID-19;citation_volume=76;citation_year=2020;citation_pmid=http://www.ncbi.nlm.nih.gov/pubmed/32387623;citation_doi=10.1016/j.jacc.2020.05.001" /> <meta name="citation_fulltext_world_readable" content="" /> <meta name="twitter:title" content="Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis" /> <meta name="twitter:card" content="summary_large_image" /> <meta name="twitter:image" content="https://thorax.bmj.com/sites/default/files/highwire/thoraxjnl/76/10.cover-source.jpg" /> <meta name="twitter:description" content="Background The prevalence of venous thromboembolic event (VTE) and arterial thromboembolic event (ATE) thromboembolic events in patients with COVID-19 remains largely unknown. Methods In this meta-analysis, we systematically searched for observational studies describing the prevalence of VTE and ATE in COVID-19 up to 30 September 2020. Results We analysed findings from 102 studies (64 503 patients). The frequency of COVID-19-related VTE was 14.7% (95% CI 12.1% to 17.6%, I2=94%; 56 studies; 16 507 patients). The overall prevalence rates of pulmonary embolism (PE) and leg deep vein thrombosis were 7.8% (95% CI 6.2% to 9.4%, I2=94%; 66 studies; 23 117 patients) and 11.2% (95% CI 8.4% to 14.3%, I2=95%; 48 studies; 13 824 patients), respectively. Few were isolated subsegmental PE. The VTE prevalence was significantly higher in intensive care unit (ICU) (23.2%, 95% CI 17.5% to 29.6%, I2=92%, vs 9.0%, 95% CI 6.9% to 11.4%, I2=95%; pinteraction<0.0001) and in series systematically screening patients compared with series testing symptomatic patients (25.2% vs 12.7%, pinteraction=0.04). The frequency rates of overall ATE, acute coronary syndrome, stroke and other ATE were 3.9% (95% CI 2.0% to to 3.0%, I2=96%; 16 studies; 7939 patients), 1.6% (95% CI 1.0% to 2.2%, I2=93%; 27 studies; 40 597 patients) and 0.9% (95% CI 0.5% to 1.5%, I2=84%; 17 studies; 20 139 patients), respectively. Metaregression and subgroup analyses failed to explain heterogeneity of overall ATE. High heterogeneity limited the value of estimates. Conclusions Patients admitted in the ICU for severe COVID-19 had a high risk of VTE. Conversely, further studies are needed to determine the specific effects of COVID-19 on the risk of ATE or VTE in less severe forms of the disease. All data relevant to the study are included in the article or uploaded as supplementary information. Data have been provided in the figures and tables." /> <meta name="og-title" property="og:title" content="Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis" /> <meta name="og-url" property="og:url" content="https://thorax.bmj.com/content/76/10/970" /> <meta name="og-site-name" property="og:site_name" content="Thorax" /> <meta name="og-description" property="og:description" content="Background The prevalence of venous thromboembolic event (VTE) and arterial thromboembolic event (ATE) thromboembolic events in patients with COVID-19 remains largely unknown. Methods In this meta-analysis, we systematically searched for observational studies describing the prevalence of VTE and ATE in COVID-19 up to 30 September 2020. Results We analysed findings from 102 studies (64 503 patients). The frequency of COVID-19-related VTE was 14.7% (95% CI 12.1% to 17.6%, I2=94%; 56 studies; 16 507 patients). The overall prevalence rates of pulmonary embolism (PE) and leg deep vein thrombosis were 7.8% (95% CI 6.2% to 9.4%, I2=94%; 66 studies; 23 117 patients) and 11.2% (95% CI 8.4% to 14.3%, I2=95%; 48 studies; 13 824 patients), respectively. Few were isolated subsegmental PE. The VTE prevalence was significantly higher in intensive care unit (ICU) (23.2%, 95% CI 17.5% to 29.6%, I2=92%, vs 9.0%, 95% CI 6.9% to 11.4%, I2=95%; pinteraction<0.0001) and in series systematically screening patients compared with series testing symptomatic patients (25.2% vs 12.7%, pinteraction=0.04). The frequency rates of overall ATE, acute coronary syndrome, stroke and other ATE were 3.9% (95% CI 2.0% to to 3.0%, I2=96%; 16 studies; 7939 patients), 1.6% (95% CI 1.0% to 2.2%, I2=93%; 27 studies; 40 597 patients) and 0.9% (95% CI 0.5% to 1.5%, I2=84%; 17 studies; 20 139 patients), respectively. Metaregression and subgroup analyses failed to explain heterogeneity of overall ATE. High heterogeneity limited the value of estimates. Conclusions Patients admitted in the ICU for severe COVID-19 had a high risk of VTE. Conversely, further studies are needed to determine the specific effects of COVID-19 on the risk of ATE or VTE in less severe forms of the disease. All data relevant to the study are included in the article or uploaded as supplementary information. Data have been provided in the figures and tables." /> <meta name="og-type" property="og:type" content="article" /> <meta name="og-image" property="og:image" content="https://thorax.bmj.com/sites/default/files/highwire/thoraxjnl/76/10.cover-source.jpg" /> <link rel="alternate" type="application/vnd.ms-powerpoint" title="Powerpoint" href="/content/76/10/970.ppt" /> <title>Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis | Thorax</title> <link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__mJqEUOzQfXK1helRRIMZQOQ1kQmuqJCtS_gHg3eCEwA__XIYCORrpa1u8qww8HC0MSBX05rwK_OicLIEmHsfVRcE__GGg7RyTnDkmyMDMex665KLqgr4r35jgL0QaeyktjHXk.css" media="all" /> <!-- OneTrust Cookies Consent Notice start --> <script src="https://cookie-cdn.cookiepro.com/scripttemplates/otSDKStub.js" type="text/javascript" charset="UTF-8" data-domain-script="565e50dd-f6e9-46d6-91cd-5c40a270264f"></script> <script type="text/javascript"> function OnetrustAdsConsent(){ 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highwire-citation-type-highwire-article node200732" data-node-nid="200732" id="node-200732--21511472241" data-pisa="thoraxjnl;76/10/970" data-pisa-master="thoraxjnl;thoraxjnl-2020-215383" data-apath="/thoraxjnl/76/10/970.atom"><cite class="highwire-cite highwire-cite-highwire-article highwire-citation-bmjj-title clearfix"> <div class="highwire-cite-title">Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis</div> <span class="highwire-cite-access"><span class="highwire-citation-access highwire-citation-access-check" data-pisa-id="thoraxjnl;thoraxjnl-2020-215383" data-atom-uri="/thoraxjnl/76/10/970.atom" data-request-view="full"></span></span> </cite> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-panel-tabs-container col-narrow-12 clear" > <div class="pane-content"> <div data-panels-ajax-tab-preloaded="jnl_template_bmjj_tab_art" id="panels-ajax-tab-container-highwire_article_tabs" class="panels-ajax-tab-container"><div class="panels-ajax-tab-loading" style ="display:none"><img class="loading" src="https://thorax.bmj.com/sites/all/modules/contrib/panels_ajax_tab/images/loading.gif" alt="Loading" title="Loading" /></div><div class="panels-ajax-tab-wrap-jnl_template_bmjj_tab_art"><div class="panel-display panel-1col clearfix" > <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-markup author-affiliates col-narrow-12 author-affiliates-corresp article" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><span class="name">Boun Kim Tan</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">1</a>, </li><li class="contributor" id="contrib-2"><span class="name">Sabine Mainbourg</span><a id="xref-aff-2-1" class="xref-aff" href="#aff-2">2</a><span class="xref-sep">,</span><a id="xref-aff-3-1" class="xref-aff" href="#aff-3">3</a>, </li><li class="contributor" id="contrib-3"><span class="name">Arnaud Friggeri</span><a id="xref-aff-1-2" class="xref-aff" href="#aff-1">1</a>, </li><li class="contributor" id="contrib-4"><a href="http://orcid.org/0000-0001-8214-3010" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0001-8214-3010</a><span class="name">Laurent Bertoletti</span><a id="xref-aff-4-1" class="xref-aff" href="#aff-4">4</a><span class="xref-sep">,</span><a id="xref-aff-5-1" class="xref-aff" href="#aff-5">5</a>, </li><li class="contributor" id="contrib-5"><span class="name">Marion Douplat</span><a id="xref-aff-6-1" class="xref-aff" href="#aff-6">6</a>, </li><li class="contributor" id="contrib-6"><span class="name">Yesim Dargaud</span><a id="xref-aff-7-1" class="xref-aff" href="#aff-7">7</a><span class="xref-sep">,</span><a id="xref-aff-8-1" class="xref-aff" href="#aff-8">8</a>, </li><li class="contributor" id="contrib-7"><span class="name">Claire Grange</span><a id="xref-aff-2-2" class="xref-aff" href="#aff-2">2</a>, </li><li class="contributor" id="contrib-8"><a href="http://orcid.org/0000-0002-8511-8432" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0002-8511-8432</a><span class="name">Hervé Lobbes</span><a id="xref-aff-2-3" class="xref-aff" href="#aff-2">2</a><span class="xref-sep">,</span><a id="xref-aff-9-1" class="xref-aff" href="#aff-9">9</a>, </li><li class="contributor" id="contrib-9"><span class="name">Steeve Provencher</span><a id="xref-aff-10-1" class="xref-aff" href="#aff-10">10</a>, </li><li class="last" id="contrib-10"><a href="http://orcid.org/0000-0002-9398-2968" class="bmjj-markup-orcid-logo" target="_blank">http://orcid.org/0000-0002-9398-2968</a><span class="name">Jean-Christophe Lega</span><a id="xref-aff-2-4" class="xref-aff" href="#aff-2">2</a><span class="xref-sep">,</span><a id="xref-aff-3-2" class="xref-aff" href="#aff-3">3</a><span class="xref-sep">,</span><a id="xref-aff-7-2" class="xref-aff" href="#aff-7">7</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address> <sup>1</sup> <span class="institution">Department of Intensive Care Unit</span>, <span class="institution">Hôpital Lyon Sud, Hospices Civils de Lyon</span>, <span class="addr-line">Pierre-Bénite</span>, France </address></li><li class="aff"><a id="aff-2" name="aff-2"></a><address> <sup>2</sup> <span class="institution">Department of Internal and Vascular Medecine</span>, <span class="institution">Hôpital Lyon Sud, Hospices Civils de Lyon</span>, <span class="addr-line">Pierre-Bénite</span>, France </address></li><li class="aff"><a id="aff-3" name="aff-3"></a><address> <sup>3</sup> <span class="institution">Equipe Evaluation et Modélisation des Effets Thérapeutiques, UMR - CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive</span>, <span class="institution">Claude Bernard University Lyon 1</span>, <span class="addr-line">VIlleurbanne</span>, France </address></li><li class="aff"><a id="aff-4" name="aff-4"></a><address> <sup>4</sup> <span class="institution">Service de Médecine Vasculaire et Thérapeutique</span>, <span class="institution">CHU de Saint-Étienne</span>, <span class="addr-line">Saint-Étienne</span>, France </address></li><li class="aff"><a id="aff-5" name="aff-5"></a><address> <sup>5</sup> <span class="institution">Université Jean-Monnet, UMR 1059, SAINBIOSE; INSERM CIC 1408</span>, <span class="addr-line">Saint-Étienne</span>, France </address></li><li class="aff"><a id="aff-6" name="aff-6"></a><address> <sup>6</sup> <span class="institution">Service d'accueil des urgences</span>, <span class="institution">Hôpital Lyon Sud, Hospices Civils de Lyon</span>, <span class="addr-line">Pierre-Bénite</span>, France </address></li><li class="aff"><a id="aff-7" name="aff-7"></a><address> <sup>7</sup> <span class="institution">Groupe d’Etude Multidisciplinaire des Maladies Thrombotiques</span>, <span class="institution">Hospices Civils de Lyon</span>, <span class="addr-line">Lyon</span>, France </address></li><li class="aff"><a id="aff-8" name="aff-8"></a><address> <sup>8</sup> <span class="institution">Unité d'Hémostase Clinique</span>, <span class="institution">Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon</span>, <span class="addr-line">Bron</span>, France </address></li><li class="aff"><a id="aff-9" name="aff-9"></a><address> <sup>9</sup> <span class="institution">Department of Internal Medicine</span>, <span class="institution">CHU de Clermont-Ferrand</span>, <span class="addr-line">Clermont-Ferrand</span>, France </address></li><li class="aff"><a id="aff-10" name="aff-10"></a><address> <sup>10</sup> <span class="institution">Pulmonary Hypertension Research Group</span>, <span class="institution">Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University</span>, <span class="addr-line">Québec City</span>, <span class="addr-line">Québec</span>, Canada </address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1"><span class="corresp-label">Correspondence to</span> Pr Jean-Christophe Lega, Internal and vascular medecine, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France; <span class="em-link"><span class="em-addr">jean-christophe.lega{at}chu-lyon.fr</span></span> </li></ol></div></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-markup abstract-with-bc" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" id="content-block" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-2"><strong>Background</strong> The prevalence of venous thromboembolic event (VTE) and arterial thromboembolic event (ATE) thromboembolic events in patients with COVID-19 remains largely unknown.</p></div><div id="sec-2" class="subsection"><p id="p-3"><strong>Methods</strong> In this meta-analysis, we systematically searched for observational studies describing the prevalence of VTE and ATE in COVID-19 up to 30 September 2020.</p></div><div id="sec-3" class="subsection"><p id="p-4"><strong>Results</strong> We analysed findings from 102 studies (64 503 patients). The frequency of COVID-19-related VTE was 14.7% (95% CI 12.1% to 17.6%, I<sup>2</sup>=94%; 56 studies; 16 507 patients). The overall prevalence rates of pulmonary embolism (PE) and leg deep vein thrombosis were 7.8% (95% CI 6.2% to 9.4%, I<sup>2</sup>=94%; 66 studies; 23 117 patients) and 11.2% (95% CI 8.4% to 14.3%, I<sup>2</sup>=95%; 48 studies; 13 824 patients), respectively. Few were isolated subsegmental PE. The VTE prevalence was significantly higher in intensive care unit (ICU) (23.2%, 95% CI 17.5% to 29.6%, I<sup>2</sup>=92%, vs 9.0%, 95% CI 6.9% to 11.4%, I<sup>2</sup>=95%; p<sub>interaction</sub><0.0001) and in series systematically screening patients compared with series testing symptomatic patients (25.2% vs 12.7%, p<sub>interaction</sub>=0.04). The frequency rates of overall ATE, acute coronary syndrome, stroke and other ATE were 3.9% (95% CI 2.0% to to 3.0%, I<sup>2</sup>=96%; 16 studies; 7939 patients), 1.6% (95% CI 1.0% to 2.2%, I<sup>2</sup>=93%; 27 studies; 40 597 patients) and 0.9% (95% CI 0.5% to 1.5%, I<sup>2</sup>=84%; 17 studies; 20 139 patients), respectively. Metaregression and subgroup analyses failed to explain heterogeneity of overall ATE. High heterogeneity limited the value of estimates.</p></div><div id="sec-4" class="subsection"><p id="p-5"><strong>Conclusions</strong> Patients admitted in the ICU for severe COVID-19 had a high risk of VTE. Conversely, further studies are needed to determine the specific effects of COVID-19 on the risk of ATE or VTE in less severe forms of the disease.</p></div></div><ul class="kwd-group"><li class="kwd">pulmonary embolism</li><li class="kwd">viral infection</li></ul><div class="section data-availability" id="sec-22"><h2 class="">Data availability statement</h2><p id="p-64">All data relevant to the study are included in the article or uploaded as supplementary information. Data have been provided in the figures and tables.</p></div><div class="license" id="license-1"><p id="p-1">This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. 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Affiliations for LB have been updated.</p></li><li class="fn-other" id="fn-16"><p id="p-60"><span class="fn-label">Contributors</span> BKT, SM, SP and J-CL designed the study. BKT and J-CL performed study selection. BKT, J-CL and SM extracted data from selected studies. J-CL and SM performed the statistical analysis. SM, BKT, J-CL, AF, YD and SP analysed the data. This first draft was written by BKT, SP and J-CL. J-CL is the guarantor. All authors contributed to the final manuscript.</p></li><li class="fn-other" id="fn-17"><p id="p-61"><span class="fn-label">Funding</span> The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.</p></li><li class="fn-conflict" id="fn-18"><p id="p-62"><span class="fn-label">Competing interests</span> LB reports grants and personal fees from Sanofi; grants, personal fees and non-financial support from Leo-Pharma; personal fees and non-financial support from Aspen; grants, personal fees and non-financial support from BMS/Bfizer; grants, personal fees and non-financial support from Bayer during the conduct of the study. CG has received grants from Bayer and BMS/Pfizer. YD has received grants/research support from Bayer, Baxter, Baxalta, Novo Nordisk, CSL Behring, LFB, Pfizer, LeoPharma, Octapharma and Stago; and an educational grant from Takeda and honoraria from Bayer, Baxter, Novo Nordisk, CSL Behring, Sobi and Octapharma. SP reports grants from Actelion, AstraZeneca and Resverlogix outside the submitted work.</p></li><li class="fn-other" id="fn-19"><p id="p-63"><span class="fn-label">Provenance and peer review</span> Not commissioned; externally peer reviewed.</p></li></ul></div></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-atom bmjj-linked-articles" id="linked-articles"> <h2 class="pane-title">Linked Articles</h2> <div class="pane-content"> <div class="highwire-atom-data-bmjj-linked-articles field field-highwire-atom-data field-label-hidden clearfix"><div class="field-items"><div class="highwire-list highwire-atom-data-list"><ul><li class="first last odd">Airwaves<div class = "highwire-article-citation bmjj-article-citation"><div class="highwire-cite"><div class="highwire-cite-title"><a href="/content/76/10/957" class="bmjj-linked-article" data-icon-position="" data-hide-link-title="0">Highlights from this issue</a></div> <div class = 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