Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov 1;4(11):e2135397.
doi: 10.1001/jamanetworkopen.2021.35397.

Factors Associated With Risk of Postdischarge Thrombosis in Patients With COVID-19

Pin Li  1 , Wei Zhao  2 , Scott Kaatz  3 , Katie Latack  1 , Lonni Schultz  1 , Laila Poisson  1
Affiliations

Factors Associated With Risk of Postdischarge Thrombosis in Patients With COVID-19

Pin Li et al. JAMA Netw Open. .

Abstract

Importance: COVID-19 is associated with a high incidence of thrombotic events; however, the need for extended thromboprophylaxis after hospitalization remains unclear.

Objective: To quantify the rate of postdischarge arterial and venous thromboembolism in patients with COVID-19, identify the factors associated with the risk of postdischarge venous thromboembolism, and evaluate the association of postdischarge anticoagulation use with venous thromboembolism incidence.

Design, setting, and participants: This is a cohort study of adult patients hospitalized with COVID-19 confirmed by a positive SARS-CoV-2 test. Eligible patients were enrolled at 5 hospitals of the Henry Ford Health System from March 1 to November 30, 2020. Data analysis was performed from April to June 2021.

Exposures: Anticoagulant therapy after discharge.

Main outcomes and measures: New onset of symptomatic arterial and venous thromboembolic events within 90 days after discharge from the index admission for COVID-19 infection were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes.

Results: In this cohort study of 2832 adult patients hospitalized with COVID-19, the mean (SD) age was 63.4 (16.7) years (IQR, 53-75 years), and 1347 patients (47.6%) were men. Thirty-six patients (1.3%) had postdischarge venous thromboembolic events (16 pulmonary embolism, 18 deep vein thrombosis, and 2 portal vein thrombosis). Fifteen (0.5%) postdischarge arterial thromboembolic events were observed (1 transient ischemic attack and 14 acute coronary syndrome). The risk of venous thromboembolism decreased with time (Mann-Kendall trend test, P < .001), with a median (IQR) time to event of 16 (7-43) days. There was no change in the risk of arterial thromboembolism with time (Mann-Kendall trend test, P = .37), with a median (IQR) time to event of 37 (10-63) days. Patients with a history of venous thromboembolism (odds ratio [OR], 3.24; 95% CI, 1.34-7.86), peak dimerized plasmin fragment D (D-dimer) level greater than 3 μg/mL (OR, 3.76; 95% CI, 1.86-7.57), and predischarge C-reactive protein level greater than 10 mg/dL (OR, 3.02; 95% CI, 1.45-6.29) were more likely to experience venous thromboembolism after discharge. Prescriptions for therapeutic anticoagulation at discharge were associated with reduced incidence of venous thromboembolism (OR, 0.18; 95% CI, 0.04-0.75; P = .02).

Conclusions and relevance: Although extended thromboprophylaxis in unselected patients with COVID-19 is not supported, these findings suggest that postdischarge anticoagulation may be considered for high-risk patients who have a history of venous thromboembolism, peak D-dimer level greater than 3 μg/mL, and predischarge C-reactive protein level greater than 10 mg/dL, if their bleeding risk is low.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Kaatz reported receiving personal fees from Norvartis, Janssen, Bristol Myers Squibb, Pfizer, CSL Behring, Portola/Alexion, and Gilead; and grants from Osmosis Research, National Institutes of Health, Bristol Myers Squibb, and Janssen outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Event Counts of Postdischarge Venous Thromboembolism, Arterial Thromboembolism, and Death Without Events
Orange lines denote kernel density.
Figure 2.
Figure 2.. Multivariable Analysis of the Factors Associated With Risk of Postdischarge Venous Thromboembolism (VTE) in Patients With COVID-19
AC indicates anticoagulation; CRP, C-reactive protein; D-dimer, dimerized plasmin fragment D; OR, odds ratio.
See this image and copyright information in PMC

References

    1. Zuin M, Rigatelli G, Zuliani G, Roncon L. The risk of thrombosis after acute-COVID-19 infection. QJM. Published online March 15, 2021. doi:10.1093/qjmed/hcab054 - DOI - PMC - PubMed
    1. Iba T, Levy JH, Levi M, Thachil J. Coagulopathy in COVID-19. J Thromb Haemost. 2020;18(9):2103-2109. doi:10.1111/jth.14975 - DOI - PMC - PubMed
    1. Mucha SR, Dugar S, McCrae K, et al. . Coagulopathy in COVID-19: manifestations and management. Cleve Clin J Med. 2020;87(8):461-468. doi:10.3949/ccjm.87a.ccc024 - DOI - PubMed
    1. Lee SG, Fralick M, Sholzberg M. Coagulopathy associated with COVID-19. CMAJ. 2020;192(21):E583-E583. doi:10.1503/cmaj.200685 - DOI - PMC - PubMed
    1. Iba T, Connors JM, Levy JH. The coagulopathy, endotheliopathy, and vasculitis of COVID-19. Inflamm Res. 2020;69(12):1181-1189. doi:10.1007/s00011-020-01401-6 - DOI - PMC - PubMed