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Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis
  1. Boun Kim Tan1,
  2. Sabine Mainbourg2,3,
  3. Arnaud Friggeri1,
  4. Laurent Bertoletti4,5,
  5. Marion Douplat6,
  6. Yesim Dargaud7,8,
  7. Claire Grange2,
  8. Hervé Lobbes2,9,
  9. Steeve Provencher10,
  10. Jean-Christophe Lega2,3,7
  1. 1 Department of Intensive Care Unit, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
  2. 2 Department of Internal and Vascular Medecine, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
  3. 3 Equipe Evaluation et Modélisation des Effets Thérapeutiques, UMR - CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive, Claude Bernard University Lyon 1, VIlleurbanne, France
  4. 4 Service de Médecine Vasculaire et Thérapeutique, CHU de Saint-Étienne, Saint-Étienne, France
  5. 5 Université Jean-Monnet, UMR 1059, SAINBIOSE; INSERM CIC 1408, Saint-Étienne, France
  6. 6 Service d'accueil des urgences, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
  7. 7 Groupe d’Etude Multidisciplinaire des Maladies Thrombotiques, Hospices Civils de Lyon, Lyon, France
  8. 8 Unité d'Hémostase Clinique, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Bron, France
  9. 9 Department of Internal Medicine, CHU de Clermont-Ferrand, Clermont-Ferrand, France
  10. 10 Pulmonary Hypertension Research Group, Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Québec, Canada
  1. Correspondence to Pr Jean-Christophe Lega, Internal and vascular medecine, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France; jean-christophe.lega{at}


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.

  • pulmonary embolism
  • viral infection

Data availability statement

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.

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.

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Data availability statement

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.

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  • Twitter @LaurentBertole1

  • SP and J-CL contributed equally.

  • Correction notice This article has been corrected since it was published Online First. Affiliations for LB have been updated.

  • Contributors 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.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests 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.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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