Post-discharge Thromboembolic Events in Patients with COVID-19

Dawn O'Shea

November 25, 2021

The findings of a new study published on  JAMA Network Open  suggest post-discharge anticoagulation therapy may be warranted for COVID-19 patients with a high risk of thromboembolism.

The cohort study included 2832 adult patients hospitalised with COVID-19 at five US hospitals from March 1 to November 30, 2020.

Thirty six patients (1.3%) experienced post-discharge venous thromboembolic events, comprising 16 pulmonary embolisms, 18 deep vein thrombosis, and two portal vein thrombosis. Fifteen (0.5%) post-discharge arterial thromboembolic events were observed - one transient ischaemic attack and 14 acute coronary syndrome cases.

The risk of venous thromboembolism (VTE) was found to decrease with time (median time to event, 16 days). There was no change in the risk of arterial thromboembolism with time (median time to event, 37 days).

Patients with a history of VTE (odds ratio [OR] 3.24; 95% CI 1.34 to 7.86), peak D-dimer level >3 μg/mL (OR 3.76; 95% CI 1.86 to 7.57), and pre-discharge C-reactive protein level >10 mg/dL (OR 3.02; 95% CI 1.45 to 6.29) were more likely to experience post-discharge VTE.

Prescriptions for therapeutic anticoagulation at discharge were associated with reduced incidence of VTE (OR 0.18; 95% CI, 0.04 to 0.75; P=0.02).

Although extended thromboprophylaxis in unselected patients with COVID-19 is not supported, the authors say these findings suggest post-discharge anticoagulation may be considered for high-risk patients.

Li P, Zhao W, Kaatz S, Latack K, Schultz L, Poisson L. Factors Associated With Risk of Postdischarge Thrombosis in Patients With COVID-19. JAMA Netw Open. 2021;4(11):e2135397. doi:10.1001/jamanetworkopen.2021.35397. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2786413

 

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