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

Reza Amani-Beni1, Mohammad Kermani-Alghoraishi2, Bahar Darouei3

  • 1Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

The Egyptian Heart Journal : (EHJ) : Official Bulletin of the Egyptian Society of Cardiology
|August 18, 2023
PubMed

Insights

Extended anticoagulant therapy after COVID-19 hospitalization is recommended for high-risk patients. Individual assessment using tools like IMPROVE-DD guides treatment duration with direct oral anticoagulants or low molecular weight heparins.

Area of Science:

  • Cardiology
  • Pulmonology
  • Infectious Diseases

Background:

  • COVID-19 is linked to an increased risk of venous thromboembolism (VTE), both during and after hospitalization.
  • This association raises concerns regarding the necessity and duration of anticoagulant (AC) use for patients post-discharge.

Purpose of the Study:

  • To systematically review the existing literature on the benefits and risks of extended thromboprophylaxis for COVID-19 patients after discharge.
  • To evaluate the evidence for anticoagulant selection and duration in this patient population.

Main Methods:

  • A comprehensive search of relevant databases was conducted from December 1, 2019, to October 6, 2022.
  • Included were 18 studies and 19 reviews/guidelines involving 52,927 hospitalized COVID-19 patients, with 19.25% receiving extended thromboprophylaxis.
  • Risk assessment models (RAMs), clinical evaluation, and laboratory data were used to identify high-VTE risk patients, with IMPROVE-DD being the most recommended RAM.

Main Results:

  • VTE events occurred in 0-8.19% of patients (median 0.7%) with a median follow-up of 49.5 days.
  • Most studies and guidelines recommended post-discharge prophylaxis based on individual risk assessment (high thrombotic, low bleeding risk).
  • Direct oral anticoagulants (DOACs) and low molecular weight heparins (LMWHs) were the most frequently used anticoagulant classes.

Conclusions:

  • Post-discharge prophylaxis for COVID-19 patients is advised following an individual risk assessment.
  • The IMPROVE-DD model aids in predicting VTE risk, guiding the use of DOACs (30-35 days) or LMWHs (40-45 days).
  • Further research, including ongoing RCTs, is needed; physicians should also consider lifestyle modifications alongside pharmacological treatment.
Abstract

Keywords:
COVID‐19Post-dischargeSystematic reviewThromboprophylaxisVenous thromboembolism

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