Deep Vein Thrombosis in Special Populations: Pregnancy, COVID-19, and the Elderly

Abstract

The purpose of this review is to examine the specific epidemiology, risk factors, pathophysiological mechanisms,
clinical complexities, and management of deep vein thrombosis (DVT) in three high-risk populations – pregnant
women, patients diagnosed with COVID-19, and older adults. A systematic literature review of peer-reviewed
meta-analyses, cohort studies, and expert guidelines examining the incidence, diagnosis, prophylaxis, and
treatment of DVT in different populations was conducted. A systematic search of the literature was conducted
on PubMed, Scopus, and the Cochrane Library based on inclusive keywords. The review incorporates both high
quality meta-analyses and large cohort studies on DVT to contrast incidence, complications, and management
strategies across settings and population groups. It is notable that considerable variation in the incidence of DVT
occurred between population groups, particularly elevated incidence in intensive care unit COVID-19 patients
and pregnant women in the peri-partum period. The elderly population presents unique barriers to diagnosis and
treatment due to polypharmacy, complications, and multimorbidity. Existing cumulative data support population
based risk stratification measures and thromboprophylaxis strategies. In this review, the importance of integrated
pathways, early risk assessments, and streamlined therapeutic choices are highlighted, as these can help to reduce
the burdens of morbidity and mortality attributed to DVT in these vulnerable populations.