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Postdischarge venous thromboembolism following hospital admission with COVID-19

Lara N Roberts1, Martin B Whyte2, Loizos Georgiou1

  • 1King's Thrombosis Centre, Department of Haematological Medicine, and.

Blood
|August 4, 2020
PubMed

Insights

Hospitalized COVID-19 patients do not have a higher risk of post-discharge venous thromboembolism (VTE) compared to other medical admissions. Further trials are needed to determine if extended VTE prevention after discharge is beneficial.

Area of Science:

  • Medicine
  • Pulmonology
  • Critical Care Medicine

Background:

  • Severe coronavirus disease 2019 (COVID-19) is associated with an increased risk of venous thromboembolism (VTE), particularly in critically ill patients.
  • Current guidelines for VTE prevention and management in COVID-19 patients are inconsistent, especially regarding post-discharge thromboprophylaxis.

Purpose of the Study:

  • To evaluate the incidence of hospital-associated VTE (HA-VTE) in COVID-19 patients within 42 days of discharge.
  • To compare the post-discharge HA-VTE risk in COVID-19 patients with that of patients discharged following other acute medical illnesses.

Main Methods:

  • A quality improvement program tracked post-discharge HA-VTE data for COVID-19 patients.
  • Data from 1877 COVID-19 discharges were analyzed, comparing outcomes to 18,159 medical discharges from 2019.
  • Root-cause analysis was incorporated to understand hospital-associated VTE events.

Main Results:

  • The post-discharge HA-VTE rate for COVID-19 patients was 4.8 per 1000 discharges (9 episodes within 42 days).
  • The 2019 medical admission cohort had an HA-VTE rate of 3.1 per 1000 discharges (56 episodes within 42 days).
  • The odds ratio for post-discharge HA-VTE in COVID-19 patients compared to 2019 medical admissions was 1.6 (95% CI, 0.77-3.1), indicating no statistically significant increase.

Conclusions:

  • Hospitalization for COVID-19 does not appear to confer a higher risk of post-discharge HA-VTE compared to other acute medical conditions.
  • The uncertain risk-benefit ratio of extended thromboprophylaxis necessitates further investigation.
  • Randomized controlled trials are required to ascertain the efficacy of continuing thromboprophylaxis in COVID-19 patients post-discharge.

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