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Risks of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19: nationwide self-controlled cases series and matched cohort study.
Katsoularis, Ioannis; Fonseca-Rodríguez, Osvaldo; Farrington, Paddy; Jerndal, Hanna; Lundevaller, Erling Häggström; Sund, Malin; Lindmark, Krister; Fors Connolly, Anne-Marie.
  • Katsoularis I; Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
  • Fonseca-Rodríguez O; Department of Clinical Microbiology, Umeå University, 90187 Umeå, Sweden.
  • Farrington P; School of Mathematics and Statistics, The Open University, Milton Keynes, UK.
  • Jerndal H; Department of Clinical Microbiology, Umeå University, 90187 Umeå, Sweden.
  • Lundevaller EH; Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden.
  • Sund M; Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden.
  • Lindmark K; Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Fors Connolly AM; Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
BMJ ; 377: e069590, 2022 04 06.
Article in English | MEDLINE | ID: covidwho-1779333
ABSTRACT

OBJECTIVE:

To quantify the risk of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19.

DESIGN:

Self-controlled case series and matched cohort study.

SETTING:

National registries in Sweden.

PARTICIPANTS:

1 057 174 people who tested positive for SARS-CoV-2 between 1 February 2020 and 25 May 2021 in Sweden, matched on age, sex, and county of residence to 4 076 342 control participants. MAIN OUTCOMES

MEASURES:

Self-controlled case series and conditional Poisson regression were used to determine the incidence rate ratio and risk ratio with corresponding 95% confidence intervals for a first deep vein thrombosis, pulmonary embolism, or bleeding event. In the self-controlled case series, the incidence rate ratios for first time outcomes after covid-19 were determined using set time intervals and the spline model. The risk ratios for first time and all events were determined during days 1-30 after covid-19 or index date using the matched cohort study, and adjusting for potential confounders (comorbidities, cancer, surgery, long term anticoagulation treatment, previous venous thromboembolism, or previous bleeding event).

RESULTS:

Compared with the control period, incidence rate ratios were significantly increased 70 days after covid-19 for deep vein thrombosis, 110 days for pulmonary embolism, and 60 days for bleeding. In particular, incidence rate ratios for a first pulmonary embolism were 36.17 (95% confidence interval 31.55 to 41.47) during the first week after covid-19 and 46.40 (40.61 to 53.02) during the second week. Incidence rate ratios during days 1-30 after covid-19 were 5.90 (5.12 to 6.80) for deep vein thrombosis, 31.59 (27.99 to 35.63) for pulmonary embolism, and 2.48 (2.30 to 2.68) for bleeding. Similarly, the risk ratios during days 1-30 after covid-19 were 4.98 (4.96 to 5.01) for deep vein thrombosis, 33.05 (32.8 to 33.3) for pulmonary embolism, and 1.88 (1.71 to 2.07) for bleeding, after adjusting for the effect of potential confounders. The rate ratios were highest in patients with critical covid-19 and highest during the first pandemic wave in Sweden compared with the second and third waves. In the same period, the absolute risk among patients with covid-19 was 0.039% (401 events) for deep vein thrombosis, 0.17% (1761 events) for pulmonary embolism, and 0.101% (1002 events) for bleeding.

CONCLUSIONS:

The findings of this study suggest that covid-19 is a risk factor for deep vein thrombosis, pulmonary embolism, and bleeding. These results could impact recommendations on diagnostic and prophylactic strategies against venous thromboembolism after covid-19.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pulmonary Embolism / Venous Thrombosis / Venous Thromboembolism / COVID-19 Type of study: Etiology study / Clinical Practice Guide / Incidence study / Observational study / Prognostic study / Risk factors Topics: Long Covid Limits: Humans Language: English Journal: BMJ Journal subject: Medicine Year: 2022 Document Type: Article Affiliation country: BMJ-2021-069590

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pulmonary Embolism / Venous Thrombosis / Venous Thromboembolism / COVID-19 Type of study: Etiology study / Clinical Practice Guide / Incidence study / Observational study / Prognostic study / Risk factors Topics: Long Covid Limits: Humans Language: English Journal: BMJ Journal subject: Medicine Year: 2022 Document Type: Article Affiliation country: BMJ-2021-069590