VENOUS THROMBOEMBOLISM SECONDARY TO HOSPITALIZATION FOR COVID-19 DISEASE: PATIENT MANAGEMENT AND LONG-TERM OUTCOMES

ABSTRACT

Background Venous thromboembolism (VTE) is a complication of COVID-19 in hospitalized patients. Little information is available on long-term outcomes of VTE in this population. We compared characteristics, management strategies, and long-term clinical outcomes between patients with COVID-19 associated VTE and patients with VTE provoked by hospitalization for other acute medical illnesses. Methods Observational cohort study, with a prospective cohort of 278 COVID-19 patients with VTE enrolled between 2020 and 2021 and a comparison cohort of 300 non-COVID-19 patients enrolled in the ongoing START2-registry between 2018 and 2020. Exclusion criteria included age <18 years, other indications to anticoagulant treatment, active cancer, recent (<3 months) major surgery, trauma, pregnancy, participation in interventional studies. All patients were followed-up for a minimum of 12 months after treatment discontinuation. Primary endpoint was the occurrence of venous and arterial thrombotic events. Results Patients with VTE secondary to COVID-19 had more frequently PE without DVT than controls (83.1% vs 46.2%, p<0.001) and a lower prevalence of chronic inflammatory disease (1.4% and 16.3%,p<0.001) and history of VTE (5.0% and 19.0%, p<0.001). The median duration of anticoagulant treatment (194 and 225 days, p=n.s.) and the proportion of patients who discontinued anticoagulation (78.0% and 75.0%, p=n.s.) were similar between the two groups. Thrombotic event rates after discontinuation were 1.5 and 2.6 per 100 patient-years, respectively (p=n.s.). Conclusions The risk of recurrent thrombotic events in patients with COVID-19 associated VTE is low and similar to the risk observed in patients with VTE secondary to hospitalization for other medical diseases.