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Incidence of symptomatic, image-confirmed venous thromboembolism following hospitalization for COVID-19 with 90-day follow-up

Although COVID-19 has been reported to be associated with high rates of venous thromboembolism (VTE), the risk of VTE and bleeding after hospitalization for COVID-19 remains unclear, and the optimal hospital VTE prevention strategy is not known. We collected retrospective observational data on throm...

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Autores principales: Salisbury, Richard, Iotchkova, Valentina, Jaafar, Sarah, Morton, Joshua, Sangha, Gavinda, Shah, Akshay, Untiveros, Paraskevi, Curry, Nicola, Shapiro, Susan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Society of Hematology 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757009/
https://www.ncbi.nlm.nih.gov/pubmed/33351117
http://dx.doi.org/10.1182/bloodadvances.2020003349
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author Salisbury, Richard
Iotchkova, Valentina
Jaafar, Sarah
Morton, Joshua
Sangha, Gavinda
Shah, Akshay
Untiveros, Paraskevi
Curry, Nicola
Shapiro, Susan
author_facet Salisbury, Richard
Iotchkova, Valentina
Jaafar, Sarah
Morton, Joshua
Sangha, Gavinda
Shah, Akshay
Untiveros, Paraskevi
Curry, Nicola
Shapiro, Susan
author_sort Salisbury, Richard
collection PubMed
description Although COVID-19 has been reported to be associated with high rates of venous thromboembolism (VTE), the risk of VTE and bleeding after hospitalization for COVID-19 remains unclear, and the optimal hospital VTE prevention strategy is not known. We collected retrospective observational data on thrombosis and bleeding in 303 consecutive adult patients admitted to the hospital for at least 24 hours for COVID-19. Patients presenting with VTE on admission were excluded. Data were collected until 90 days after admission or known death by using medical records and an established national VTE network. Maximal level of care was ward based in 78% of patients, with 22% requiring higher dependency care (12% noninvasive ventilation, 10% invasive ventilation). Almost all patients (97.0%) received standard thromboprophylaxis or were already receiving therapeutic anticoagulation (17.5%). Symptomatic image-confirmed VTE occurred in 5.9% of patients during index hospitalization, and in 7.2% at 90 days after admission (23.9% in patients requiring higher dependency care); half the events were isolated segmental or subsegmental defects on lung imaging. Bleeding occurred in 13 patients (4.3%) during index hospitalization (1.3% had major bleeding). The majority of bleeds occurred in patients on the general ward, and 6 patients were receiving treatment-dose anticoagulation, highlighting the need for caution in intensifying standard thromboprophylaxis strategies. Of 152 patients discharged from the hospital without an indication for anticoagulation, 97% did not receive thromboprophylaxis after discharge, and 3% received 7 days of treatment with low molecular weight heparin after discharge. The rate of symptomatic VTE in this group at 42 days after discharge was 2.6%, highlighting the need for large prospective randomized controlled trials of thromboprophylaxis after discharge in COVID-19.
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spelling pubmed-77570092020-12-23 Incidence of symptomatic, image-confirmed venous thromboembolism following hospitalization for COVID-19 with 90-day follow-up Salisbury, Richard Iotchkova, Valentina Jaafar, Sarah Morton, Joshua Sangha, Gavinda Shah, Akshay Untiveros, Paraskevi Curry, Nicola Shapiro, Susan Blood Adv Thrombosis and Hemostasis Although COVID-19 has been reported to be associated with high rates of venous thromboembolism (VTE), the risk of VTE and bleeding after hospitalization for COVID-19 remains unclear, and the optimal hospital VTE prevention strategy is not known. We collected retrospective observational data on thrombosis and bleeding in 303 consecutive adult patients admitted to the hospital for at least 24 hours for COVID-19. Patients presenting with VTE on admission were excluded. Data were collected until 90 days after admission or known death by using medical records and an established national VTE network. Maximal level of care was ward based in 78% of patients, with 22% requiring higher dependency care (12% noninvasive ventilation, 10% invasive ventilation). Almost all patients (97.0%) received standard thromboprophylaxis or were already receiving therapeutic anticoagulation (17.5%). Symptomatic image-confirmed VTE occurred in 5.9% of patients during index hospitalization, and in 7.2% at 90 days after admission (23.9% in patients requiring higher dependency care); half the events were isolated segmental or subsegmental defects on lung imaging. Bleeding occurred in 13 patients (4.3%) during index hospitalization (1.3% had major bleeding). The majority of bleeds occurred in patients on the general ward, and 6 patients were receiving treatment-dose anticoagulation, highlighting the need for caution in intensifying standard thromboprophylaxis strategies. Of 152 patients discharged from the hospital without an indication for anticoagulation, 97% did not receive thromboprophylaxis after discharge, and 3% received 7 days of treatment with low molecular weight heparin after discharge. The rate of symptomatic VTE in this group at 42 days after discharge was 2.6%, highlighting the need for large prospective randomized controlled trials of thromboprophylaxis after discharge in COVID-19. American Society of Hematology 2020-12-16 /pmc/articles/PMC7757009/ /pubmed/33351117 http://dx.doi.org/10.1182/bloodadvances.2020003349 Text en © 2020 by The American Society of Hematology This article is made available via the PMC Open Access Subset for unrestricted reuse and analyses in any form or by any means with acknowledgment of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.
spellingShingle Thrombosis and Hemostasis
Salisbury, Richard
Iotchkova, Valentina
Jaafar, Sarah
Morton, Joshua
Sangha, Gavinda
Shah, Akshay
Untiveros, Paraskevi
Curry, Nicola
Shapiro, Susan
Incidence of symptomatic, image-confirmed venous thromboembolism following hospitalization for COVID-19 with 90-day follow-up
title Incidence of symptomatic, image-confirmed venous thromboembolism following hospitalization for COVID-19 with 90-day follow-up
title_full Incidence of symptomatic, image-confirmed venous thromboembolism following hospitalization for COVID-19 with 90-day follow-up
title_fullStr Incidence of symptomatic, image-confirmed venous thromboembolism following hospitalization for COVID-19 with 90-day follow-up
title_full_unstemmed Incidence of symptomatic, image-confirmed venous thromboembolism following hospitalization for COVID-19 with 90-day follow-up
title_short Incidence of symptomatic, image-confirmed venous thromboembolism following hospitalization for COVID-19 with 90-day follow-up
title_sort incidence of symptomatic, image-confirmed venous thromboembolism following hospitalization for covid-19 with 90-day follow-up
topic Thrombosis and Hemostasis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757009/
https://www.ncbi.nlm.nih.gov/pubmed/33351117
http://dx.doi.org/10.1182/bloodadvances.2020003349
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