Effectiveness and safety of extended thromboprophylaxis in post-discharge patients with COVID-19: A systematic review and meta-analysis

Dai, Meng-Fei; Xin, Wenjuan; Kong, Sijia; Ding, Haiying; Fang, Luo

doi:10.1016/j.thromres.2022.11.019

Cited by 13 publications

(7 citation statements)

References 29 publications

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“…Also for postdischarge thromboprophylaxis, a large meta-analysis from 10,148 7 patients showed that extending preventive anticoagulation after hospital discharge in these patients for <35 days with direct oral anticoagulation protects against all-cause mortality and thrombosis with OR: 0.62; 95% CI: 0.42-0.94, P = .023; I 2 = 30.2%, and this without an increase in bleeding events.…”

Section: Discussionmentioning

confidence: 99%

“…In the MICHELLE randomized trial, 6 which compared the benefit of extending preventive anticoagulation with rivaroxaban 10 mg daily for 35 days in patients with at least 3 days of prior ICU stay for COVID-19 infection, all of whom received preventive anticoagulation with heparin during hospitalization: 3.14% under rivaroxaban developed a thromboembolic event versus 9.43% in the placebo group, with a relative risk of 0.33 (P = .0293) for all combined thromboembolic events without superiority over hemorrhagic events. Also for postdischarge thromboprophylaxis, a large metaanalysis from 10,148 7 patients showed that extending preventive anticoagulation after hospital discharge in these patients for <35 days with direct oral anticoagulation protects against all-cause mortality and thrombosis with OR: 0.62; 95% CI: 0.42-0.94, P = .023; I 2 = 30.2%, and this without an increase in bleeding events.…”

Section: Discussionmentioning

confidence: 99%

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The Efficacy and Safety of Prolonged Oral Anticoagulation for the Prevention of Thromboembolic Events in Patients Recovered From COVID-19 1 Year After Hospital Discharge: The SARCOV-19 Prospective Registry

Aidouni

Bouchlarhem

Bkiyar

et al. 2023

Clin Appl Thromb Hemost

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Our objective in this study is to know the predictors of thromboembolic events 1 year after hospitalization for severe COVID-19 and the benefit of preventive oral anticoagulation for 1 month to placebo after release. We conducted a prospective study to determine the benefit of preventive anticoagulation upon discharge from the hospital and to determine the predictive factors of thromboembolic events. We included 720 patients in the SARCOV-19 Registry, with a mean age of 62.07 (±18.11), and 61.1% male. After 1 year, 60 thromboembolic events were observed, 45 in patients on a placebo, and 15 in patients on a direct oral anticoagulant. The predictive factors determined for these events were the presence of cardiac disease, elevation of D-dimer during hospitalization, myocardial damage defined by elevation of troponins more than 6 times normal, and the use of mechanical ventilation. However, the use of preventive anticoagulation protects against thrombotic events and reduces the risk of a thromboembolic event at 1 year with a relative risk of 0.49 compared to a placebo. The prolongation of the preventive anticoagulation at the exit will protect with a decrease of almost 50% of the risk against thrombotic events and this without increasing the risk of bleeding.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of Prolonged Oral Anticoagulation for the Prevention of Thromboembolic Events in Patients Recovered From COVID-19 1 Year After Hospital Discharge: The SARCOV-19 Prospective Registry

Aidouni

Bouchlarhem

Bkiyar

et al. 2023

Clin Appl Thromb Hemost

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“…Similar to our findings, extended thromboprophylaxis did not increase the risk of major bleeding events (OR: 1.64; 95 % CI: 0.95–2.82, p = 0.075). 41…”

Section: Discussionmentioning

confidence: 99%

“…Similar to our findings, extended thromboprophylaxis did not increase the risk of major bleeding events (OR: 1.64; 95 % CI: 0.95-2.82, p = 0.075). 41 Studies have shown that patients hospitalized after a COVID-19 positive test had a higher risk of dying up to 12 months after discharge compared to COVID-19 negative patients, 42 and that the majority of post-COVID-19 discharge mortality appears to occur within 30 days after discharge. 43 We continue to learn effects and impacts of post COVID-19 syndrome on different organ systems and potential complications.…”

Section: Discussionmentioning

confidence: 99%

Outcomes in patients discharged with extended venous thromboembolism prophylaxis after hospitalization with COVID-19

et al. 2023

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Background: Venous thromboembolism (VTE) is a known complication of coronavirus disease (COVID-19) in patients requiring hospitalization and intensive care. We examined the association between extended pharmacological VTE prophylaxis and outcomes among patients hospitalized with COVID-19. Methods: This was a retrospective cohort study of patients with an index positive SARS-CoV-2 polymerase chain reaction (PCR) test at the time of, or during hospitalization. Patients who were prescribed extended pharmacological VTE prophylaxis were compared against patients who were not. Multivariable logistic regression was used to produce odds ratio (OR) estimates and Cox proportional hazard models for hazard ratios (HR) with 95% CI to examine the association between pharmacological VTE prophylaxis and outcomes of interest. Primary outcomes were 30- and 90-day VTE events. Secondary outcomes included 30- and 90-day mortality, 30-day superficial venous thrombosis (SVT), acute myocardial infarction (MI), acute ischemic stroke, critical limb ischemia, clinically significant bleeding, and inpatient readmissions. Results: A total of 1936 patients were included in the study. Among them, 731 (38%) were discharged on extended pharmacological VTE prophylaxis. No significant difference was found in 30- and 90-day VTE events among groups. Patients discharged on extended VTE prophylaxis showed improved survival at 30 (HR: 0.35; 95% CI: 0.21–0.59) and 90 days (HR: 0.36; 95% CI: 0.23–0.55) and reduced inpatient readmission at 30 days (OR: 0.12; 95% CI: 0.04–0.33) when compared to those without. Conclusion: Patients discharged on extended VTE prophylaxis after hospitalization due to COVID-19 had similar thrombotic events on follow-up. However, use of extended VTE prophylaxis was associated with improved 30- and 90-day survival and reduced risk of 30-day inpatient readmission.

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“…In a recent meta-analysis of eight observational studies, thromboprophylaxis decreased the composite outcome of thrombosis and postdischarge mortality without a substantial increased risk for bleeding. 10 The much-anticipated MICHELLE trial evaluated hospitalized patients with COVID-19 and an increased risk for venous thromboembolism (VTE) identified using combined risk stratification tools (IMPROVE score) and blood D-dimer concentration > 500 ng/mL. Patients were randomized 1:1 to postdischarge prophylactic anticoagulation consisting of rivaroxaban (10 mg daily) or placebo for 35 days.…”

mentioning

confidence: 99%

Thromboprophylaxis for COVID-19: Time to ask for an extension?

Cameron

Carman

2023

Vasc Med

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Effectiveness and safety of extended thromboprophylaxis in post-discharge patients with COVID-19: A systematic review and meta-analysis

Cited by 13 publications

References 29 publications

The Efficacy and Safety of Prolonged Oral Anticoagulation for the Prevention of Thromboembolic Events in Patients Recovered From COVID-19 1 Year After Hospital Discharge: The SARCOV-19 Prospective Registry

The Efficacy and Safety of Prolonged Oral Anticoagulation for the Prevention of Thromboembolic Events in Patients Recovered From COVID-19 1 Year After Hospital Discharge: The SARCOV-19 Prospective Registry

Outcomes in patients discharged with extended venous thromboembolism prophylaxis after hospitalization with COVID-19

Thromboprophylaxis for COVID-19: Time to ask for an extension?

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