Arterial thrombosis in coronavirus disease 2019 (COVID-19) patients: A rapid systematic review

Abstract

Background Emerging evidence suggests that severe form of COVID-19 is mediated, in part, by a hypercoagulable state characterized by micro- and macrovascular thrombotic angiopathy. Whereas venous thrombotic events in COVID-19 patients has been well described, data on arterial thrombosis (AT) in these patients is still limited. We, therefore, conducted a rapid systematic review of current scientific literature to identify and consolidate evidence of AT in COVID-19 patients. Methods A systematic search of literature was conducted between 1st November 2019 and 9th June 2020 on PubMed and China National Knowledge Infrastructure to identify potentially eligible studies. Results A total of 27 studies (5 cohort, 5 case series & 17 case reports) describing arterial thrombotic events in 90 COVID-19 patients were included. The pooled incidence of AT in severe/critically ill ICU-admitted COVID-19 patients across the 5 cohort studies was 4.4% (95% CI 2.8-6.4). Most of the patients were male, elderly and had comorbidities. AT was symptomatic in >95% of these patients, and involved multiple arteries in about 18% of patients. The anatomical distribution of arterial thrombotic events was wide, occurring in limb arteries (39%), cerebral arteries (24%), great vessels (aorta, common iliac, common carotid and brachiocephalic trunk) (19%); coronary arteries (9%) and superior mesenteric artery (8%). Mortality rate in these patients is about 20%. Conclusion Arterial thrombosis occurs in approximately 4% of critically-ill COVID-19 patients. It often presents symptomatically, and can affect multiple arteries. Further investigation of the underlying mechanism of AT in COVID-19 would be needed to clarify possible therapeutic targets