Postdischarge venous thromboembolism following hospital admission with COVID-19

Abstract

The association of severe COVID-19 with an increased risk of VTE has resulted in specific guidelines for its prevention and management. The VTE risk appears highest in those with critical care admission. The need for post discharge thromboprophylaxis remains controversial and this is reflected in the conflicting recommendations of expert guidelines. Our local protocol provides thromboprophylaxis to COVID-19 patients during admission only. We report post-discharge VTE data from an ongoing quality improvement programme incorporating root cause analysis of hospital-associated VTE (HA-VTE). Following 1,877 hospital discharges associated with COVID-19, there were 9 episodes of HA-VTE diagnosed within 42 days, to give a post-discharge rate of 4.8 per 1000 discharges. Over 2019, following 18,159 discharges associated with a medical admission; there were 56 episodes of HA-VTE within 42 days (3.1 per 1000 discharges). The odds ratio for post-discharge HA-VTE associated with COVID-19 compared to 2019 was 1.6 (95% CI 0.77-3.1). Hospitalisation with COVID-19 does not appear to increase the risk of post-discharge HA-VTE compared to hospitalisation with other acute medical illness. Given the risk-benefit ratio of post discharge thromboprophylaxis remains uncertain, randomised controlled trials to evaluate the role of continuing thromboprophylaxis in patients with COVID-19 following hospital discharge are required.

Registry of Arterial and Venous Thromboembolic Complications in Patients With COVID-19

“…Because we did not study a comparator group without COVID-19 but with other medical illness of similar severity, we were unable to determine the extent to which COVID-19 itself increases the risk of thromboembolic events. A U.K.-based study of 1,877 hospital discharges related to COVID-19 and 18,159 related to non-COVID-19 medical illness did not show a difference in the rate of hospitalization-associated VTE (OR: 1.6; 95% CI: 0.77 to 3.1) ( 33 ).…”

Incidence of symptomatic venous thromboembolism following hospitalization for coronavirus disease 2019: Prospective results from a multi-center study

“…Preliminary analyses tested whether the risk of VTE extends after the acute phase and, consequently, a post-discharge thromboprophylaxis may be recommended [ 12 , 13 ]. Our study, the largest to the best of our knowledge, confirmed that the rate of VTE appears low after hospital discharge, similar to other unselected populations of medically ill patients.…”

“…In a survey of hospital charts integrated in an institutional quality program in London, the authors described a 0.5% rate of VTE within 42 days of hospital discharge [ 12 ]. In a retrospective cohort of 163 hospitalized patients, the 30-day post-discharge cumulative incidence of VTE was 0.6% [ 13 ].…”

Thromboembolism and the Pandemic

“…As such, Roberts et al. ( 5 ) found that post–hospital discharge–associated VTE rates for COVID-19 patients (4.8 per 1,000 hospital discharges) did not differ compared with 2019 pre-COVID-19 rates (3.1 per 1,000 hospital discharges; odds ratio: 1.6; 95% confidence interval: 0.77 to 3.1; p = 0.20). The PROTECT trial ( 6 ), published in 2011, compared prophylaxis with low-molecular-weight heparin to unfractionated heparin in 3,764 ICU patients.…”

“…Proximal leg DVT was identified in 5.1% and 5.8% whereas PE rates were 1.3% and 2.3% for patients receiving dalteparin and unfractionated heparin, respectively. Additional pre-COVID-19 estimates of VTE rates from hospitalized patients in the ICU and ward setting have comparable frequencies ( Table 1 ) ( 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ). It would therefore appear that VTE rates reported in the current study are similar to expected rates for patients hospitalized without COVID-19.…”