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. 2021 Dec:208:4-10.
doi: 10.1016/j.thromres.2021.10.001. Epub 2021 Oct 8.

Risk of symptomatic venous thromboembolism in mild and moderate COVID-19: A comparison of two prospective European cohorts

Delphine Douillet  1 , Jérémie Riou  2 , Andrea Penaloza  3 , Thomas Moumneh  4 , Caroline Soulie  5 , Dominique Savary  6 , Francois Morin  7 , Rafaël Mahieu  8 , Pierre-Marie Roy  4
Affiliations

Risk of symptomatic venous thromboembolism in mild and moderate COVID-19: A comparison of two prospective European cohorts

Delphine Douillet et al. Thromb Res. 2021 Dec.

Abstract

Background: Severely ill patients with SARS-CoV-2 have an increased risk of venous thromboembolism (VTE) i.e., deep vein thrombosis and pulmonary embolism. However, the VTE risk in patients with mild and moderate COVID-19, hospitalized or managed at home, remain uncertain. The aims of this study were to assess the rate and the risk factors symptomatic VTE, in patients with mild and moderate COVID-19 and to compare them to a cohort of similar patients without COVID-19.

Methods: Patients presenting to the emergency department (ED) of participating centers for confirmed or probable mild or moderate COVID-19 and not having acute VTE were included. This COVID-19 cohort was retrospectively compared to a prospective cohort of similar ED patients using propensity score matching. The main outcome was the rate of symptomatic VTE within the 28 days after ED presentation.

Results: A total of 2292 patients were included in the COVID-19 cohort. The 28-day incidence of symptomatic VTE was 1.3% (n = 29/2292, 95%CI: 0.9 to 1.8), 2.3% (n = 20/866, 95%CI: 1.5 to 3.5) in moderate COVID-19 patients and 0.6% (n = 9/1426; 95%CI: 0.3 to 1.2) in mild COVID-19 patients managed as outpatients. An age over 65 years and hospitalization were independent risk factors of VTE. After adjustment, patients in the COVID-19 cohort had an absolute increase in over symptomatic VTE risk of +1.69% (95%CI, 0.88 to 2.51) versus patients in the comparison cohort (n = 1539).

Conclusions: Patients with moderate COVID-19 presenting to the ED had a high risk of subsequent VTE.

Trial registration: Ethics committee of the CHU of Angers (N°2020/87).

Keywords: COVID-19; SARS-CoV-2 infection; VTE risk; Venous thromboembolism.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Kaplan-Meier cumulative VTE rate for the primary outcome. Kaplan-Meier curves are shown for the first occurence of the primary outcome of symtomatic venous thromboembolism (VTE) - a composite of deep-vein thrombosis or pulmonary embolism - within 28 days.
Fig. 2
Fig. 2
Kaplan-Meier cumulative VTE rate for the primary outcome in the two subgroups: A. Hospitalized patients. B. Outpatients. Kaplan-Meier curves are shown for the occurence of the primary outcome of symptomatic venous thromboembolism (VTE) - a composite of deep-vein thrombosis or pulmonary embolism - within 28 days.
Fig. 3
Fig. 3
Hazard Ratios for the venous thromboembolism rate within 28 days in different subgroups according to different levels of COVID-19 probability. VTE: venous thromboembolism, RT-PCR: reverse transcriptase-polymerase chain reaction, CT-Scan: computed-tomography scan, COVID-19: Coronavirus Infectious Disease 2019.
Fig. S1
Fig. S1
Love plot for balance in baseline characteristics. COPD: Chronic Obstructive Pulmonary Disease, RT-PCR: Reverse Transcriptase – Polymerase Chain Reaction for SARS-CoV-2.
See this image and copyright information in PMC

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