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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

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