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

Abstract

Background Coronavirus disease 2019 (COVID‐19) is associated with high rates of thromboembolic events in hospitalized patients. It remains to be determined if this risk persists following hospital discharge. Methods We conducted a retrospective cohort study of outpatients recently hospitalized for COVID‐19 to determine the incidence of vascular thromboembolic events within 30 days of discharge. We investigated the risk factors associated with these events, including intensive care admission, age, and anticoagulation. Results Among 447 patients hospitalized for COVID‐19, 2.0% experienced a vascular thromboembolic event within 30 days of discharge. No risk factor variable was significantly associated with an increased risk for these events. Conclusions The incidence of vascular thromboembolic events following hospital discharge for COVID‐19 is low. These findings suggest against the routine use of postdischarge thromboprophylaxis in patients with COVID‐19.

Long COVID, a comprehensive systematic scoping review

“…Of the 120 publications (Table 2 ), 67 (55.9%) presented original data as follows: 43 (35.9%) were original articles/papers [ 20 – 62 ]. Fifteen (12.5%) publications were short articles with original data, as follows: 7 brief communications/reports [ 63 – 69 ] (5 cohort and 1 cross-sectional studies, and 1 case series), 1 commentary [ 70 ] (cross-sectional study), 6 letters to editors [ 71 – 76 ] (4 cross-sectional and 1 cohort studies, and 1 case series), and 1 short communication [ 77 ]. Fifty-four (45%) articles did not present original data.…”

“…Fifty-nine (49.2%) articles presented signs and symptoms of Long COVID. Twenty-three (19.2%) articles reported on the generalized signs/symptoms (21 adults, 2 pediatrics), and the remaining 36 (30%) articles focused on specific organs/systems (9 focused on thromboembolism [ 29 , 30 , 36 , 50 , 66 , 69 , 114 , 117 , 118 ], 8 respiratory [ 23 , 27 , 37 , 41 , 44 , 67 , 75 , 127 ], 4 neurology [ 46 , 61 , 102 , 116 ], 2 musculoskeletal [ 53 , 72 ], 5 cardiovascular [ 39 , 49 , 54 , 112 , 120 ], 3 mental health [ 21 , 58 , 108 ], 2 Multisystem Inflammatory Syndrome [MIS] [ 43 , 113 ] (one about pediatrics MIS [ 43 ] and one on adults MIS [ 113 ]), 1 skin manifestations [ 70 ], 2 were exclusively about post-acute infectious fatigue [ 33 , 122 ].

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“…Similarly, a multi-center study showed that the incidence of venous thromboembolism in COVID-19 patients who were followed for 45 days after hospitalization was “relatively low”[ 29 ]. Moreover, Eswaran et al, reported that among 447 patients who were followed after discharge from the hospital, only 2% developed vascular thromboembolism 30 days after discharge; and they concluded against the routine post-discharge thromboprophylaxis [ 69 ]. In light of these controversies, there is an urgent need for more extensive randomized clinical trials.…”

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

“…The American College of Chest Physicians has previously defined a threshold symptomatic thrombotic risk of 1.0% in control groups to define an “at‐VTE” or “moderate‐VTE” risk hospitalized medically ill population that would benefit from pharmacologic thromboprophylaxis. 2 Although it should be acknowledged that the rate of symptomatic pulmonary emboli in the study by Eswaran et al 1 was ≈0.7%, nearly half of the population had received postdischarge thromboprophylaxis. In addition, applying the criteria used by the authors to define a 2.0% symptomatic thrombotic incidence as “low risk,” no hospitalized medically ill patient—including those with pneumonia and sepsis—would in theory benefit from in‐hospital pharmacologic thromboprophylaxis, as the incidence of symptomatic VTE seen in control groups in the early pivotal trials of thromboprophylaxis in hospitalized medically ill patients was ≈1.5%.…”

“…We read with interest the retrospective cohort study by Eswaran et al 1 that found a 2.0% incidence of symptomatic thromboembolic events in a cohort of 447 hospitalized patients with coronavirus disease 2019 (COVID‐19) within 30 days of discharge. These events encompassed both arterial and venous thromboembolic events (ATEs and VTEs), including four non–ST‐segment–elevation myocardial infarctions, three pulmonary emboli, one ischemic stroke, and one splenic infarct.…”