ABSTRACT
Background: The incidence of venous thromboembolism (VTE) in patients with COVID-19 during hospitalization and in the post-discharge setting has been reported with wide variability. Many studies have short follow-up, reported the early phase of the pandemic, or did not report bleeding or anticoagulant dosing. Aim(s): We determined the incidence of symptomatic VTE and bleeding in patients admitted to hospital for COVID-19 and their 3-month risk of VTE post-discharge. Method(s): All patients admitted for COVID-19 at 5 regional hospitals were identified between January 1 and December 31, 2020. Data were collected from their hospital admission and for a minimum of 3 months post-discharge. Re-admissions during this period were considered as post-discharge data of the index admission. Standard thromboprophylaxis for critical care and ward patients were enoxaparin 30 mg twice daily or 40 mg once daily. Post-discharge thromboprophylaxis was not given. Patient consent was waived by the institutional research ethics board. Result(s): A total of 565 patients were included. Baseline demographics are reported in Table 1. Median length-of- stay was 9.0 days (range 5-131). 178 patients (31.5%) required critical care support and 79 patients (14%) died during index admission. 25 patients (4.4%) had VTE during hospitalization, of which 17 occurred within first 2 weeks and none occurred in those on therapeutic anticoagulation. There were no fatal bleeds. 5 patients (0.88%) developed critical site bleeding. Patient characteristics, anticoagulant use and bleeding rates during hospitalization are reported in Table 2. Among 486 discharged patients, median length of follow-up was 163 days (range 3-600): 63.5% had at least 90 days of follow-up data and 18.7% were lost to follow-up. 5 patients (1.3%) had symptomatic VTE diagnosed within 3 months after discharge. Conclusion(s): The in-hospital incidence of VTE in COVID-19 was lower but post-discharge incidence was higher than other studies. Therapeutic anticoagulation appeared protective against symptomatic VTE. (Table Presented).
ABSTRACT
Background: Disasters, including pandemics, disproportionately affect vulnerable populations. The Downtown Eastside (DTES) neighborhood of Vancouver has high prevalence of mental illness, substance use, infectious disease and homelessness. While studies have described clinical characteristics of COVID-19 patients in other centres worldwide, data is lacking on marginalized groups. We describe the clinical characteristics and outcomes of COVID-19 patients seen at two urban hospitals who care for the vulnerable population in the DTES of Vancouver, British Columbia (BC), Canada. Methods: A retrospective chart review was conducted on all COVID-19 patients ≥19 years seen at either centre from January 1 to June 10, 2020. Descriptive statistics assessed demographics, comorbidities, presenting symptoms, laboratory values and outcomes, and were compared between subjects managed as inpatients (died vs. discharged) and outpatients. Results: Of 71 COVID-19 subjects, mean age was 57y (SD 20);36 (51%) were male. Time to presentation, symptoms and laboratory values were similar to other reports. 58 (82%) presented from the community, 3 (4%) from long-term care/rehabilitation centres, and 8 (11%) had no fixed address (NFA) or lived in the DTES. 45 (64%) had a known exposure, 20 (28%) were healthcare workers, 85% involved in direct patient care;0/20 were admitted to hospital. Of the 8 NFA/DTES subjects, mean age was 46y (SD 13), 50% were male, 5 (63%) were admitted to hospital and all survived. Admitted subjects (n=34) were older (mean age 69 vs 46y, p< 0.001), 62% were male, and had more comorbidities (mean [SD] 3 [3] vs. 1 [2], p< 0.001). Eight (24%) died, 26 (76%) were discharged, 29% developed acute respiratory distress syndrome, 21% secondary infection, 18% renal failure, and 15% cardiac dysfunction. Of patients admitted to intensive care, 5/10 died. Conclusion: Our results concur with other studies showing older age and comorbidities contribute to more severe COVID-19 disease. 64% of subjects had a known exposure, and only 11% had NFA/DTES residence. Given that there is no financial barrier to access healthcare in Canada and these hospitals serve our most vulnerable populations, our results may indicate that BC Public Health has done an effective job of tracking and limiting community spread of COVID-19.