Frequency of venous thromboembolism in 6513 patients with COVID-19: a retrospective study

Abstract

Patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appear to be at increased risk for venous thromboembolism (VTE), especially if they become critically ill with COVID-19. Some centers have reported very high rates of thrombosis despite anticoagulant prophylaxis. The electronic health record (EHR) of a New Orleans–based health system was searched for all patients with polymerase chain reaction–confirmed SARS-CoV-2 infection who were either admitted to hospital or treated and discharged from an emergency department between 1 March 2020 and 1 May 2020. From this cohort, patients with confirmed VTE (either during or after their hospital encounter) were identified by administrative query of the EHR.: Between 1 March 2020 and 1 May 2020, 6153 patients with COVID-19 were identified; 2748 of these patients were admitted, while 3405 received care exclusively through the emergency department. In total, 637 patients required mechanical ventilation and 206 required renal replacement therapy. Within the hospitalized cohort, the overall mortality rate was 24.5% and VTE occurred in 86 patients (3.1%). In the 637 patients who required mechanical ventilation at some point during their hospital stay, 45 developed VTE (7.2%). After a median follow-up of 14.6 days, VTE had been diagnosed in 3 of the 2075 admitted who were discharged alive (0.14%). Among 6153 patients with COVID-19 who were hospitalized or treated in emergency departments, we did not find evidence of unusually high VTE risk. Pending further evidence from prospective, controlled trials, our findings support a traditional approach to primary VTE prevention in patients with COVID-19.

High rate of bleeding and arterial thrombosis in COVID-19: Saudi multicenter study

“…For VTE, all events except for one occurred in the ICU. The rate of VTE in the current study was much lower than that in previously published studies [ 10 – 14 ] but consistent with that in other studies [ 15 – 18 ]. In a multicenter study in the Netherlands ( n = 184) [ 11 ] in which all patients were admitted to the ICU and received standardized doses of nadroparin and a dose escalation to 5700 IU BID at some point during admission in selected patients, the cumulative composite outcome of venous and arterial events was 49 % when adjusting for a competing risk of death.…”

“…Propensity score matching was used, and it was determined that the COVID-19 ARDS patients had higher rates of thrombotic events than those with non-COVID-19 ARDS (11.7 % versus 2.1 %). In one of the largest studies that included 6513 patients (637 patients required mechanical ventilation), the rate of VTE within the hospitalized cohort was 3.1 %, and that in the subgroup of patients who required mechanical ventilation at any time during hospitalization was 7.2 % [ 15 ]. In another multicenter retrospective study with 400 admitted COVID-19 patients, the VTE (confirmed or presumed) rates were 6 %, 3.91 % and 10.4 % in all patients, noncritically ill patients and critically ill patients, respectively [ 16 ].…”

“…Several observational studies have reported the rate of venous and arterial thrombotic events in patients infected with COVID-19, with conflicting results. Early studies showed an increased risk of thrombosis in COVID-19 patients, especially in critically ill patients, with a crude cumulative composite outcome of venous and arterial events of 57 % [ 10 – 14 ] However, some studies reported a low rate of thrombotic events [ 15 – 18 ]. The aim of this multicenter study was to estimate the rate of thrombotic and bleeding events in hospitalized patients diagnosed with COVID-19 in Saudi Arabia.…”

Vascular thromboembolic events following COVID‐19 hospital discharge: Incidence and risk factors

“…We found that the incidence of postdischarge VaTE following admission for COVID‐19 is low but not negligible. Our findings are in line with published literature reporting a cumulative VaTE incidence of 2.5%, with VTE rates ranging from 0.14% to 0.6% following COVID‐19 hospital discharge 2‐4 . Although we did not compare COVID to non‐COVID discharges, other studies have also reported low 30‐day postdischarge VTE incidence rates that do not significantly differ between medical patients with and without COVID‐19 2 .…”

“…While we attempted to adjust for significant confounders in our logistic regression model (age and ICU admission), it is possible that there were other unmeasured risk factors that contributed to differences in use of postdischarge anticoagulation. In addition, we considered whether higher inpatient anticoagulation dosing may have contributed to the low incidence of outpatient events, but we found a comparable rate of outpatient VaTEs as studies that used standard dose prophylaxis in inpatients 2‐4 . Finally, the low number of VaTEs in our patient cohort, as well as the confounding influence of postdischarge anticoagulation, limited our ability to investigate the impact of other risk factors on the outcome.…”