Venous Thromboembolism in Patients Discharged after COVID-19 Hospitalization

Abstract

Background Venous thromboembolism (VTE) is a frequent complication of COVID-19, so that the importance of adequate in-hospital thromboprophylaxis in patients hospitalized with COVID-19 is well established. However, the incidence of VTE after discharge and whether postdischarge thromboprophylaxis is beneficial and safe are unclear. In this prospective observational single-center study, we report the incidence of VTE 6 weeks after hospitalization and the use of postdischarge thromboprophylaxis. Methods Patients hospitalized with confirmed COVID-19 were invited to a multidisciplinary follow-up clinic 6 weeks after discharge. D-dimer and C-reactive protein were measured, and all patients were screened for deep vein thrombosis with venous duplex-ultrasound. Additionally, selected high-risk patients received computed tomography pulmonary angiogram or ventilation–perfusion (V/Q) scan to screen for incidental pulmonary embolism. Results Of 485 consecutive patients hospitalized from March through June 2020, 146 patients were analyzed, of which 39% had been admitted to the intensive care unit (ICU). Postdischarge thromboprophylaxis was prescribed in 28% of patients, but was used more frequently after ICU stay (61%) and in patients with higher maximal D-dimer and C-reactive protein levels during hospitalization. Six weeks after discharge, elevated D-dimer values were present in 32% of ward and 42% of ICU patients. Only one asymptomatic deep vein thrombosis (0.7%) and one symptomatic pulmonary embolism (0.7%) were diagnosed with systematic screening. No bleedings were reported. Conclusion In patients who had been hospitalized with COVID-19, systematic screening for VTE 6 weeks after discharge revealed a low incidence of VTE. A strategy of selectively providing postdischarge thromboprophylaxis in high-risk patients seems safe and potentially effective.

Incidence of venous thromboembolic events in COVID-19 patients after hospital discharge: A systematic review and meta-analysis

“…A total of 266 articles were obtained using our search strategy. After excluding duplicates and preliminary screening, 96 full-text articles were assessed for eligibility, 87 studies were excluded for not meeting the inclusion criteria and 2 records were identified using other sources, leaving 11 investigations fulfilling the inclusion criteria ( Supplementary File 2 ) [3] , [4] , [5] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] .…”

“…Overall, 18,949 COVID-19 patients were included in this analysis ( Table 1 ). Only four analyses reported the mean hospitalization length, which was 19.5 days [3] , [4] , [11] . Few investigations reported data regarding the administration of post-discharge prophylactic or therapeutic anticoagulation [3] , [4] , [5] , [10] , [11] , [12] , [14] .…”

“…Only four analyses reported the mean hospitalization length, which was 19.5 days [3] , [4] , [11] . Few investigations reported data regarding the administration of post-discharge prophylactic or therapeutic anticoagulation [3] , [4] , [5] , [10] , [11] , [12] , [14] . Eight studies also reported the rate of intensive care unit (ICU) admission during index hospitalization [4] , [5] , [8] , [10] , [11] , [12] , [13] , [14] .…”

“…However, the risk of hospital-associated VTE extends from the time of admission and over the first 90 days post hospital discharge also in COVID-19 patients. [2] , [3] , [4] , [5] , [6] . To this regard, the actual post-discharge cumulative incidence of VTE events in patients hospitalized for COVID-19 pneumonia has not been clearly determined, limiting the formulation of clinical recommendations regarding the need for and optimal duration of extended thromboprophylaxis strategies.…”

Late‐onset hematological complications post COVID‐19: An emerging medical problem for the hematologist

“…At 6 weeks, 32% of ward patients and 42% of ICU patients had elevated D‐dimer levels. 20 In another outpatient cohort study of 175 patients, at 60 days the incidence of arterial events was 0% and venous events 0.71% (1 PE at 9 days post discharge), and no bleedings were reported. 21 Similar rates were also reported from a Chinese study of post‐acute COVID‐19 .…”