Venous thromboembolism (VTE) prevention and diagnosis in COVID-19: Practice patterns and outcomes at 33 hospitals

Abstract

Background Early reports of increased thrombosis risk with SARS-CoV-2 infection led to changes in venous thromboembolism (VTE) management. Real-world data on the prevalence, efficacy and harms of these changes informs best practices. Objective Define practice patterns and clinical outcomes related to VTE diagnosis, prevention, and management in hospitalized patients with coronavirus disease-19 (COVID-19) using a multi-hospital US sample. Methods In this retrospective cross-sectional study of 1121 patients admitted to 33 hospitals, exposure was dose of anticoagulant prescribed for VTE prophylaxis (standard, intensified, therapeutic), and primary outcome was VTE (pulmonary embolism [PE] and deep vein thrombosis [DVT]); secondary outcomes were PE, DVT, arterial thromboembolism (ATE), and bleeding events. Multivariable logistic regression models accounting for clustering by site and adjusted for risk factors were used to estimate odds ratios (ORs). Inverse probability weighting was used to account for confounding by indication. Results 1121 patients (mean age 60 ± 18, 47% female) admitted with COVID-19 between February 2, 2020 and December 31, 2020 to 33 US hospitals were included. Pharmacologic VTE prophylaxis was prescribed in 86%. Forty-seven patients (4.2%) had PE, 51 (4.6%) had DVT, and 23 (2.1%) had ATE. Forty-six patients (4.1%) had major bleeding and 46 (4.1%) had clinically relevant non-major bleeding. Compared to standard prophylaxis, adjusted odds of VTE were 0.67 (95% CI 0.21–2.1) with no prophylaxis, 1.0 (95% CI 0.06–17) with intensified, and 3.0 (95% CI 0.89–10) with therapeutic. Adjusted odds of bleeding with no prophylaxis were 5.6 (95% CI 3.0–11) and 5.3 (95% CI 3.0–10) with therapeutic (no events on intensified dosing). Conclusions Therapeutic anticoagulation was associated with a 3-fold increased odds of VTE and 5-fold increased odds of bleeding. While higher bleeding rates with high-intensity prophylaxis were likely due to full-dose anticoagulation, we conclude that high thrombosis rates were due to clinical concern for thrombosis before formal diagnosis.

Review of clinical characteristics and mortality outcomes in patients on maintenance hemodialysis during the Omicron surge: a single center experience

“…Studies have con rmed that infection with SARS-CoV-2 can induce a massive thrombotic state [41][42][43]. We have also observed this phenomenon, and clinicians at our dialysis center found that even when receiving anticoagulant doses (1000-3000IU) of low molecular weight heparin, some patients still found that intravenous pot dialyzer tubing developed during dialysis.…”

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

“…Nevertheless, three cohorts and one cross-sectional study implied no role for post-discharge thromboprophylaxis [ 20 , 23 – 25 ]. Additionally, three cohort studies did not provide a definite opinion on this matter [ 26 – 28 ].…”

Review of clinical characteristics and mortality outcomes in patients on maintenance hemodialysis during the Omicron surge: a single center experience

“…Studies have confirmed that infection with SARS-CoV-2 can induce a massive thrombotic state [ 41 – 43 ]. We have also observed this phenomenon, and clinicians at our dialysis center found that even when receiving anticoagulant doses (1000-3000IU) of low molecular weight heparin, some patients still found that intravenous pot dialyzer tubing developed during dialysis.…”