Postdischarge thrombosis and hemorrhage in patients with COVID-19

Abstract

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.

COVID-19 Infection: Viral Macro- and Micro-Vascular Coagulopathy and Thromboembolism/Prophylactic and Therapeutic Management

“…According to a retrospective observational cohort study of 163 COVID-19 patients who were discharged from the hospital without receiving anticoagulation, the cumulative incidence of thrombosis (including arterial and venous events) at day 30 following discharge was 2.5% (95% CI 0.8-7.6), of VTE 0.6% (95% CI 0.1-4.6) and of major hemorrhage 0.7% (95% CI 0.1-5.1) with clinically relevant non-major bleeds at 2.9% (95% CI 1.0-9.1). 60…”

Anticipating the long-term cardiovascular effects of COVID-19

“…The frequency of cardiac injury, vascular dysfunction and thrombosis in patients with COVID-19, including those persons with either no or minimal symptoms during their initial infection, raises important questions about potential longterm cardiovascular effects: these could include heart failure, life-threatening arrhythmias, sudden cardiac death, impaired myocardial flow reserve from microvascular injury, coronary artery and aorta aneurysm formation, hypertension, labile heart rate and blood pressure responses to activity, accelerated atherosclerosis and both venous and arterial thromboembolic disease [2]. Indeed, events during the acute phase of disease, including those that are clinically unsuspected and undiagnosed [3] will increase the risk for recurring events [4][5][6]. How will the medical community follow patients with COVID-19?…”

Incidence of symptomatic venous thromboembolism following hospitalization for coronavirus disease 2019: Prospective results from a multi-center study

“…In a survey of hospital charts integrated in an institutional quality program in London, the authors described a 0.5% rate of VTE within 42 days of hospital discharge [ 12 ]. In a retrospective cohort of 163 hospitalized patients, the 30-day post-discharge cumulative incidence of VTE was 0.6% [ 13 ]. These numbers suggest that post-discharge VTE rates are comparable in COVID-19 and non-COVID-19 patients.…”