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. 2023 May;7(4):100167.
doi: 10.1016/j.rpth.2023.100167. Epub 2023 Apr 26.

Venous thromboembolism secondary to hospitalization for COVID-19: patient management and long-term outcomes

Walter Ageno  1 , Emilia Antonucci  2 , Daniela Poli  3 , Eugenio Bucherini  4 , Antonio Chistolini  5 , Vittorio Fregoni  6 , Teresa Lerede  7 , Roberta Pancani  8 , Simona Pedrini  9 , Filippo Pieralli  10 , Pasquale Pignatelli  11 , Attilia Maria Pizzini  12 , Gian Marco Podda  13 , Nicola Potere  14 , Luca Sarti  15 , Sophie Testa  16 , Adriana Visonà  17 , Gualtiero Palareti  2 ; START 2 Registry VTE study group
Collaborators, Affiliations

Venous thromboembolism secondary to hospitalization for COVID-19: patient management and long-term outcomes

Walter Ageno et al. Res Pract Thromb Haemost. 2023 May.

Abstract

Background: Venous thromboembolism (VTE) is a complication of COVID-19 in hospitalized patients. Little information is available on long-term outcomes of VTE in this population.

Objectives: We aimed to compare the characteristics, management strategies, and long-term clinical outcomes between patients with COVID-19-associated VTE and patients with VTE provoked by hospitalization for other acute medical illnesses.

Methods: This is an observational cohort study, with a prospective cohort of 278 patients with COVID-19-associated VTE enrolled between 2020 and 2021 and a comparison cohort of 300 patients without COVID-19 enrolled in the ongoing START2-Register between 2018 and 2020. Exclusion criteria included age <18 years, other indications to anticoagulant treatment, active cancer, recent (<3 months) major surgery, trauma, pregnancy, and participation in interventional studies. All patients were followed up for a minimum of 12 months after treatment discontinuation. Primary end point was the occurrence of venous and arterial thrombotic events.

Results: Patients with VTE secondary to COVID-19 had more frequent pulmonary embolism without deep vein thrombosis than controls (83.1% vs 46.2%, P <.001), lower prevalence of chronic inflammatory disease (1.4% and 16.3%, P <.001), and history of VTE (5.0% and 19.0%, P <.001). The median duration of anticoagulant treatment (194 and 225 days, P = 0.9) and the proportion of patients who discontinued anticoagulation (78.0% and 75.0%, P = 0.4) were similar between the 2 groups. Thrombotic event rates after discontinuation were 1.5 and 2.6 per 100 patient-years, respectively (P = 0.4).

Conclusion: The risk of recurrent thrombotic events in patients with COVID-19-associated VTE is low and similar to the risk observed in patients with VTE secondary to hospitalization for other medical diseases.

Keywords: COVID-19; anticoagulant treatment; pulmonary embolism; recurrence; venous thromboembolism.

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Figures

Figure
Figure
Kaplan-Meier curves for cumulative thrombotic event rates after treatment discontinuation in patients with COVID-19 and controls. IRR, incidence rate ratio.
See this image and copyright information in PMC

References

    1. Tan B.K., Mainbourg S., Friggeri A., Bertoletti L., Douplat M., Dargaud Y., et al. Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis. Thorax. 2021;76:970–979. - PubMed
    1. Porfidia A., Valeriani E., Pola R., Porreca E., Rutjes A.W.S., Di Nisio M. Venous thromboembolism in patients with COVID-19: systematic review and meta-analysis. Thromb Res. 2020;196:67–74. - PMC - PubMed
    1. Levi M., Thachil J., Iba T., Levy J.H. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020;7:e438–e440. doi: 10.1016/S2352-3026(20)30145-9. - DOI - PMC - PubMed
    1. O’Sullivan J.M., Gonagle D.M., Ward S.E., Preston R.J.S., O’Donnell J.S. Endothelial cells orchestrate COVID-19 coagulopathy. Lancet Haematol. 2020;7 doi: 10.1016/S2352-3026(20)30215-5v. - DOI - PMC - PubMed
    1. Spyropoulos A.C., Levy J.H., Ageno W., Connors J.M., Hunt B.J., Iba T., et al. Scientific and Standardization Committee communication: clinical guidance on the diagnosis, prevention, and treatment of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost. 2020;18:1859–1865. - PMC - PubMed

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