A systematic review on post-discharge venous thromboembolism prophylaxis in patients with COVID-19

Abstract

Background Coronavirus disease of 2019 (COVID-19) is associated with venous thromboembolism (VTE), not only during hospitalization but also after discharge, raising concerns about anticoagulant (AC) use for post-discharge COVID-19 patients. We aimed to systematically review the current literature on the possible benefits or risks regarding extended thromboprophylaxis. Main body We searched related databases from December 1, 2019, to October 6, 2022, including studies on the necessity, duration, and selection of the ideal AC regarding extended thromboprophylaxis for post-discharge COVID-19 patients. The screening of the selected databases led to 18 studies and 19 reviews and guidelines. Studies included 52,927 hospitalized COVID-19 patients, with 19.25% receiving extended thromboprophylaxis. VTE events ranging from 0 to 8.19% (median of 0.7%) occurred in a median follow-up of 49.5 days. All included studies and guidelines, except four studies, recommended post-discharge prophylaxis after an individual risk assessment indicating high thrombotic and low bleeding risk. Studies used risk assessment models (RAMs), clinical evaluation, and laboratory data to identify COVID-19 patients with a high risk of VTE. IMPROVE-DD was the most recommended RAM. Direct oral anticoagulants (DOACs) and low molecular weight heparins (LMWHs) were the most used AC classes. Conclusions Post-discharge prophylaxis for COVID-19 patients is recommended after an individual assessment. The IMPROVE-DD model can help predict VTE risk. After distinguishing patients who need post-discharge AC therapy, DOACs for 30–35 days and LMWHs for 40–45 days can be the drug of choice. Further studies, particularly the results of the ongoing randomized controlled trials (RCTs), are required. Also, to properly handle such patients, every physician should consider lifestyle modification in addition to pharmacological treatment for post-discharge VTE prophylaxis.

High-risk subgroups were not identified to benefit from thromboprophylaxis after hospitalization for COVID-19

“…The ACTIV-4c trial results are similar to incidence of thrombosis seen in similar patient cohorts. Several meta-analyses have summarized postdischarge arterial and venous thrombosis over the course of the pandemic [ [15] , [16] , [17] ]. The first meta-analysis of 11 studies showed a cumulative postdischarge pooled incidence of VTE of 1.8% [ 15 ].…”

Dynamics of clinical and laboratory parameters of patients with COVID-19 on the background of treatment

“…Given this situation, the diagnosis of clinical and laboratory criteria for thrombotic risk stratification is a priority for clinical trials to optimize thromboprophylaxis [15].…”