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Early reports from China and Europe indicated that incidence of venous thromboembolism in COVID-19 patients may be high. In this meta-analysis of observational studies was designed to know worldwide prevalence of thromboembolic events in COVID-19 patients. Primary outcome of our review was to assess the proportion of patients with VTE. Secondary outcomes were to assess the proportion of patients with DVT and proportion of patients with PE. Random effect meta-analysis model with restricted maximum likelihood estimator was used for all analysis. Pooled proportion with 95% confidence interval (95% CI) and heterogeneity (I2) was reported for all outcomes. Data of 5426 patients from n=19 articles were included in this systematic review and meta-analysis. Incidence of VTE (95% CI), PE (95% CI) and DVT (95% CI) was 23 (10-36) %, 12 (6-17) % and 15 (8-23) %. We have found a high but incidence of thromboembolic events in COVID-19 patients. Further well-designed studies are required in this area to identify true incidence and risk factors of it. O_LSTKey MessagesC_LSTO_LIThis meta-analysis of observational studies was designed to know worldwide prevalence of thromboembolic events in COVID-19 patients. C_LIO_LIData of more than 5000 patients from 19 observational studies were analyzed in this meta-analysis. C_LIO_LIIncidence of venous thromboembolism may be as high as 36% in these patients. C_LI
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Background/ObjectiveThere is a paucity of data on the management of gastrointestinal (GI) bleeding in patients with COVID-19 amid concerns about the risk of transmission during endoscopic procedures. We aimed to study the outcomes of conservative treatment for GI bleeding in patients with COVID-19. MethodsIn this retrospective analysis, 24 of 1342 (1.8%) patients with COVID-19, presenting with GI bleeding from 22 April to 22 July 2020, were included. ResultsThe mean age of patients was 45.8{+/-}12.7 years; 17 (70.8%) were males; upper GI (UGI) bleeding: lower GI (LGI) 23:1. Twenty-two (91.6%) patients had evidence of cirrhosis-21 presented with UGI bleeding while one had bleeding from hemorrhoids. Two patients without cirrhosis were presumed to have non-variceal bleeding. The medical therapy for UGI bleeding included vasoconstrictors-somatostatin in 17 (73.9%) and terlipressin in 4 (17.4%) patients. All patients with UGI bleeding received proton pump inhibitors and antibiotics. Packed red blood cells (PRBCs), fresh frozen plasma and platelets were transfused in 14 (60.9%), 3 (13.0%) and 3 (13.0%), respectively. The median PRBCs transfused was 1 (0-3) unit(s). The initial control of UGI bleeding was achieved in all 23 patients and none required an emergency endoscopy. At 5-day follow-up, none rebled or died. Two patients later rebled, one had intermittent bleed due to gastric antral vascular ectasia, while another had rebleed 19 days after discharge. Three (12.5%) cirrhosis patients succumbed to acute hypoxemic respiratory failure during hospital stay. ConclusionConservative management strategies including pharmacotherapy, restrictive transfusion strategy, and close hemodynamic monitoring can successfully manage GI bleeding in COVID-19 patients and reduce need for urgent endoscopy. The decision for proceeding with endoscopy should be taken by a multidisciplinary team after consideration of the patients condition, response to treatment, resources and the risks involved, on a case to case basis.
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A novel coronavirus was reported in Wuhan, China in December 2019 to cause severe acute respiratory symptoms (COVID-19). In this meta-analysis, we estimated case fatality rate from COVID-19 infection by random effect meta-analysis model with country level data. Publicly accessible web database WorldOMeter (https://www.worldometers.info/coronavirus/) was accessed on 24th March 2020 GMT and reported total number of cases, total death, active cases and seriously ill/ critically ill patients were retrieved. Primary outcome of this meta-analysis was case fatality rate defined by total number of deaths divided by total number of diagnosed cases. Pooled case fatality rate (95% CI) was 1.78 (1.34-2.22) %. Between country heterogeneity was 0.018 (p<0.0001). Pooled estimate of composite poor outcome (95% CI) was 4.06 (3.24-4.88) % at that point of time after exclusion of countries reported small number of cases. Pooled mortality rate (95% CI) was 33.97 (27.44-40.49) % amongst closed cases (where patients have recovered or died) with. Meta regression analysis identified statistically significant association between health expenditure and case fatality rate (p=0.0017).