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Risks of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19: nationwide self-controlled cases

Ioannis Katsoularis1, Osvaldo Fonseca-Rodríguez2, Paddy Farrington3

  • 1Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.

BMJ (Clinical Research Ed.)
|April 7, 2022
PubMed

Insights

COVID-19 significantly increases the risk of deep vein thrombosis, pulmonary embolism, and bleeding. These findings highlight the need for updated diagnostic and prophylactic strategies for patients recovering from coronavirus disease 2019.

Area of Science:

  • Cardiovascular Medicine
  • Infectious Diseases
  • Public Health

Background:

  • COVID-19 (coronavirus disease 2019) has been associated with thrombotic events.
  • The precise quantification of risks for deep vein thrombosis (DVT), pulmonary embolism (PE), and bleeding post-COVID-19 requires further investigation.

Purpose of the Study:

  • To quantify the risk of deep vein thrombosis, pulmonary embolism, and bleeding following COVID-19 infection.
  • To compare these risks against a baseline control period and assess the impact of confounding factors.

Main Methods:

  • A self-controlled case series and matched cohort study design utilizing Swedish national registries.
  • Inclusion of over 1 million individuals diagnosed with SARS-CoV-2 (the virus causing COVID-19) and matched controls.
  • Statistical analysis using conditional Poisson regression to determine incidence rate ratios and risk ratios.

Main Results:

  • Significantly elevated incidence rate ratios for DVT, PE, and bleeding were observed up to 70-110 days post-COVID-19.
  • During days 1-30 post-COVID-19, risk ratios were substantially increased: 5.90 for DVT, 31.59 for PE, and 2.48 for bleeding.
  • Absolute risks at 30 days included 0.039% for DVT, 0.17% for PE, and 0.101% for bleeding, with highest rates in critical COVID-19 cases and during the first pandemic wave.

Conclusions:

  • COVID-19 is confirmed as a significant risk factor for deep vein thrombosis, pulmonary embolism, and bleeding.
  • These findings necessitate a re-evaluation of diagnostic and prophylactic strategies for venous thromboembolism in the post-COVID-19 recovery phase.
Abstract

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