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

Abstract

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.

A Delphi consensus on the management of anticoagulation in the COVID-19 pandemic: the MONACO study

“…In the absence of contraindication, panellists recommended to initiate DOACs or switch to DOACs in patients diagnosed with AF during hospitalisation or in patients previously anticoagulated with VKAs, respectively. In a study with 1,936 hospitalised patients, VTE prophylaxis was associated with enhanced survival rates at 30 and 90 days and reduced likelihood readmission 30 days after discharge ( 69 ).…”

Dysregulated Platelet Function in Patients with Post-Acute Sequelae of COVID-19

“…In a large observational study of COVID-19 patients who never experienced thrombosis, no additional risk for VTE after hospitalization with acute SARS-CoV-2 infection was noted after hospital discharge 16 . Contrasting this, the MICHELLE study suggested a beneficial effect of an oral Factor Xa inhibitor on discharged patients by protecting against DVT if the patient was were previously hospitalized, even without an initial thrombotic event 17 .…”