Patients infected with COVID-19 frequently present with both arterial thromboembolism (ATE) and venous thromboembolism (VTE), due to induction of coagulopathy manifested by an elevation in the level of the D-fragment of dimerized plasmin.

A recent study thus evaluated the rate of post-discharge thrombosis in patients with COVID-19, identified the factors associated with the risk of post-discharge VTE and evaluated the association of the use of post-discharge anticoagulants with the incidence of VTE.

Led by Pin Li, PhD, Department of Public Health Sciences, Henry Ford Health System, the team of investigators found that patients at high risk of developing VTE after discharge from hospital may benefit most of the use of therapeutic anticoagulation after discharge.

Methods

The scan consisted of adult patients hospitalized with a diagnosis of COVID-19 confirmed by a positive polymerase chain reaction test at all 5 hospitals in the Henry Ford Health System from March to November 2020. They noted that the first events VTE or ATE had been identified up to 90 days after discharge from index admission, with event and death rates calculated at 90 days.

Electronic health records obtained patient demographics, body mass index, pre-existing medical conditions, inpatient data, advanced and pre-discharge lab results, use of air conditioning during l hospitalization and after discharge.

Investigators noted that race was assessed in the study due to black patients having higher rates of VTE and pulmonary embolism compared to patients of other races.

In the statistical analysis, investigators used a Mann-Kendall nonparametric trend test to test for the monotonic trend in the number of events over time after discharge.

In addition, univariate and multivariate logistic regression methods assessed risk and drug-associated factors for thrombosis. Additionally, propensity scores were used to assess the association between post-discharge air conditioning use and the onset of VTE.

Results

The cohort study included 2,832 adult patients hospitalized for COVID-19, with an average age of 63.4 years, 47.6% male (n = 1347), 38.9% black (n = 1102) and 50.7% Whites (n = 1437).

Of this total, 36 (1.3%) had a new onset of VTE after discharge, of whom 16 had pulmonary embolism, 18 had deep vein thrombosis, and 2 had portal vein thrombosis. In addition, 15 patients (0.5%) with COVID-19 had a new onset of ETA after discharge, 1 had a transient ischemic attack, and 14 had acute coronary syndrome.

Data show that the incidence of VTE decreased over time, with a median time to event of 16 days (Mann-Kendall trend test, P <.001 but they did not observe any change in the risk of ate over time trend test>P = 0.37), at a median time to event of 37 days. Over time, mortality decreased (Mann-Kendall trend test, P <.001 with a median time to death of days.>

Among factors associated with increased risk, multivariate analysis results showed that patients with pre-discharge CRP levels ≥10 mg / dL (OR, 3.02; 95% CI, 1.45 – 6.29), peak D-dimer levels ≥2 μg / mL (OR, 3.76; 95% CI, 1.86 – 7.57) and pre-discharge C-reactive protein level ≥ 10 mg / dL (OR, 3.02; 95% CI, 1.45 – 6.29) were more likely to have VTE after discharge.

Li and colleagues noted that 682 patients (24.1%) received AC on discharge, with 188 patients (6.6%) receiving a prophylactic dose and 494 patients (17.4%) receiving a dose therapeutic.

Those who received therapeutic AC at discharge had a reduced risk of developing VTE (OR, 0.18; 95% CI, 0.04 – 0.75, P = .02).

Take away food

“Although prolonged thromboprophylaxis in unselected patients with COVID-19 is not supported, these results suggest that post-discharge anticoagulation may be considered for high-risk patients who have a history of venous thromboembolism,” a peak in D-dimers greater than 3 g / mL, and C-reactive protein level before discharge greater than 10 mg / dL, if their bleeding risk is low, ”the investigators wrote.

The study, “Factors associated with the risk of post-discharge thrombosis in patients with COVID-19,” was published in JAMA network open.