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Factors Associated With Risk of Postdischarge Thrombosis in Patients With COVID-19.
Li, Pin; Zhao, Wei; Kaatz, Scott; Latack, Katie; Schultz, Lonni; Poisson, Laila.
  • Li P; Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan.
  • Zhao W; Department of Internal Medicine, Ascension St John Hospital, Detroit, Michigan.
  • Kaatz S; Division of Hospital Medicine, Henry Ford Health System, Detroit, Michigan.
  • Latack K; Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan.
  • Schultz L; Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan.
  • Poisson L; Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan.
JAMA Netw Open ; 4(11): e2135397, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1527393
ABSTRACT
Importance COVID-19 is associated with a high incidence of thrombotic events; however, the need for extended thromboprophylaxis after hospitalization remains unclear.

Objective:

To quantify the rate of postdischarge arterial and venous thromboembolism in patients with COVID-19, identify the factors associated with the risk of postdischarge venous thromboembolism, and evaluate the association of postdischarge anticoagulation use with venous thromboembolism incidence. Design, Setting, and

Participants:

This is a cohort study of adult patients hospitalized with COVID-19 confirmed by a positive SARS-CoV-2 test. Eligible patients were enrolled at 5 hospitals of the Henry Ford Health System from March 1 to November 30, 2020. Data analysis was performed from April to June 2021. Exposures Anticoagulant therapy after discharge. Main Outcomes and

Measures:

New onset of symptomatic arterial and venous thromboembolic events within 90 days after discharge from the index admission for COVID-19 infection were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes.

Results:

In this cohort study of 2832 adult patients hospitalized with COVID-19, the mean (SD) age was 63.4 (16.7) years (IQR, 53-75 years), and 1347 patients (47.6%) were men. Thirty-six patients (1.3%) had postdischarge venous thromboembolic events (16 pulmonary embolism, 18 deep vein thrombosis, and 2 portal vein thrombosis). Fifteen (0.5%) postdischarge arterial thromboembolic events were observed (1 transient ischemic attack and 14 acute coronary syndrome). The risk of venous thromboembolism decreased with time (Mann-Kendall trend test, P < .001), with a median (IQR) time to event of 16 (7-43) days. There was no change in the risk of arterial thromboembolism with time (Mann-Kendall trend test, P = .37), with a median (IQR) time to event of 37 (10-63) days. Patients with a history of venous thromboembolism (odds ratio [OR], 3.24; 95% CI, 1.34-7.86), peak dimerized plasmin fragment D (D-dimer) level greater than 3 µg/mL (OR, 3.76; 95% CI, 1.86-7.57), and predischarge C-reactive protein level greater than 10 mg/dL (OR, 3.02; 95% CI, 1.45-6.29) were more likely to experience venous thromboembolism after discharge. Prescriptions for therapeutic anticoagulation at discharge were associated with reduced incidence of venous thromboembolism (OR, 0.18; 95% CI, 0.04-0.75; P = .02). Conclusions and Relevance Although extended thromboprophylaxis in unselected patients with COVID-19 is not supported, these findings suggest that postdischarge anticoagulation may be considered for high-risk patients who have a history of venous thromboembolism, peak D-dimer level greater than 3 µg/mL, and predischarge C-reactive protein level greater than 10 mg/dL, if their bleeding risk is low.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Discharge / Thrombosis / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Aged / Female / Humans Language: English Journal: JAMA Netw Open Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Discharge / Thrombosis / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Aged / Female / Humans Language: English Journal: JAMA Netw Open Year: 2021 Document Type: Article