Coronavirus Disease-2019 (COVID-19) is associated with a prothrombotic state with a high incidence of thrombotic events during hospitalization; however there are limited data examining rates of thrombosis after discharge. We conducted a retrospective observational cohort study of discharged patients with confirmed COVID-19 not receiving anticoagulation. The cohort included 163 patients with median time from discharge to last recorded follow up of 30 days (IQR 17-46). The median duration of index hospitalization was 6 days (IQR 3-12) and 26% required intensive care. The cumulative incidence of thrombosis (including arterial and venous events) at day 30 following discharge was 2.5% (95% CI 0.8-7.6); the cumulative incidence of venous thromboembolism alone at day 30 post-discharge was 0.6% (95% CI 0.1-4.6). The 30-day cumulative incidence of major hemorrhage was 0.7% (95% CI 0.1-5.1) and clinically relevant non-major bleeds was 2.9% (95% CI 1.0-9.1). We conclude that the rates of thrombosis and hemorrhage appear to be similar following hospital discharge for COVID-19, emphasizing the need for randomized data to inform recommendations for universal post-discharge thromboprophylaxis.

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Background Coronavirus disease‐2019 (COVID‐19) is a recognized prothrombotic state. Patients hospitalized with active cancer are predisposed to thrombosis but whether active cancer further amplifies thrombotic risk with COVID‐19 is not known. Objectives To evaluate cumulative incidences of thrombotic and hemorrhagic events in hospitalized COVID‐19 patients with and without active cancer at 28 days. Methods A retrospective cohort analysis of consecutive adults hospitalized with COVID‐19 was performed. Active cancer required cancer‐directed therapy within previous 6 months. The cumulative incidences of thrombosis or hemorrhage were estimated considering death as a competing risk. Results Patients without cancer (n = 353) and active cancer (n = 45) were comparable in terms of age, sex, antibiotics administered, length of hospitalization, and critical care. The most common malignancies were lymphoid (17.8%), gastrointestinal (15.6%), lung (13.3%), and genitourinary (13.3%). At day 28, the cumulative incidence of thrombotic events was 18.2% (95% confidence interval [CI], 10.2%‐27.9%) in the non‐cancer cohort and 14.2% (95% CI, 4.7%‐28.7%) in the cancer cohort. The cumulative incidence of major and fatal bleeding at day 28 was 20.8% (95% CI, 12.1%‐31.0%) in the non‐cancer group and 19.5% (95% CI, 5.5%‐39.8%) in the cancer cohort. Three patients experienced fatal bleeds, all of whom were in the non‐cancer cohort. Survival was significantly shorter in the group with active cancer (P = .038). Conclusions We observed a similarly high incidence of thrombosis and bleeding among patients admitted with COVID‐19 with or without active cancer.