Post-Hospital Venous Thromboembolism in Patients With COVID-19
- Venous thromboembolism (VTE) was not common following hospitalization for COVID-19.
- Rates of VTE were similar for patients with COVID-19 as for all patients with a medical hospital discharge.
- Use of post-hospital VTE prophylaxis should be selective based on key risk factors.
What is the risk of venous thromboembolism (VTE) following hospitalization for coronavirus disease 2019 (COVID-19)?
The authors conducted an analysis of patients discharged from two hospitals in London, United Kingdom, for COVID-19 between March 3–May 7, 2020. All patients received in-hospital VTE prophylaxis, but none received post-hospital prophylaxis. Routine screening for VTE was not performed. The primary outcome of interest was the development of hospital-associated VTE within 90 days of hospital discharge. Events and rates per 1,000-discharge were compared to all medically ill hospitalizations in 2019.
Of the 1,877 hospital admissions with COVID-19 during the study period, 208 (11.1%) were admitted to critical care. There were 84 episodes of hospital-associated VTE, of which nine (11%) occurred in the post-discharge period. These post-discharge VTE events occurred at a median of 8 days (range 3-33). Post-hospital VTE occurred at a rate of 4.8/1,000 discharged (within 42 days of discharge). Of the post-hospital VTE events, two were proximal DVT and seven were pulmonary embolism. One of the patients did not receive chemoprophylaxis during the index hospital stay due to active bleeding. In 2019, there were 18,159 hospital discharges for medical illness, with 85 post-hospital VTE events (rate 3.1/1,000 discharges at 42 days). Post-discharge VTE was not significantly elevated among patients with COVID-19 as compared to those in 2019 (odds ratio, 1.6; 95% confidence interval, 0.77-3.1).
The authors concluded that the rate of post-hospital VTE among patients with COVID-19 is low and that routine post-hospital prophylaxis is not necessary.
This is the first large study published examining post-hospital VTE rates among patients with COVID-19. While the absolute numbers are re-assuring, a few caveats should be considered. First, only 11% were deemed to be in critical care. Second, the sample size precludes the ability from identifying which patients were more likely to develop VTE. The rates of VTE are lower than those seen in recent randomized controlled trials of post-hospital prophylaxis (1.0% in the MAGELLAN trial, 1.5% in the APEX trial), suggesting that further efforts at risk stratification may be useful. Future studies will help to validate these findings in different populations. In the meantime, routine post-hospital VTE prophylaxis is not recommended for patients with COVID-19. However, select patients at high risk for VTE may still benefit from prevention, as described in the MAGELLAN and/or APEX trials.
Keywords: Anticoagulants, Coronavirus, COVID-19, Critical Care, Diagnostic Tests, Routine, Hemorrhage, Patient Admission, Patient Discharge, Post-Exposure Prophylaxis, Pulmonary Embolism, Risk, Secondary Prevention, Thrombosis, Vascular Diseases, Venous Thrombosis, Venous Thromboembolism
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