SARS‐CoV‐2 infection and venous thromboembolism after surgery: an international prospective cohort study

Abstract

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

Risk stratification for SARS‐CoV‐2‐related venous thromboembolic events: time for a new paradigm?

“…If there is a ‘ceiling effect’ of VTE risk in patients undergoing emergency surgery, we might expect a smaller increased risk of VTE in patients with SARS‐CoV‐2 infection undergoing emergency vs. elective surgery. Data presented in this article confirm this [ 6 ]. In patients undergoing emergency surgery, those with peri‐operative SARS‐CoV‐2 infection have only a slight increase in VTE risk compared with those without (OR = 1.26).…”

Molecular Insights of SARS-CoV-2 Antivirals Administration: A Balance between Safety Profiles and Impact on Cardiovascular Phenotypes

“…Cardiovascular complications are distributed in various forms of COVID-19 and various populations [ 125 , 126 , 127 , 128 ]. The tendency is to be cautious with repurposed drugs administration, for COVID-19.…”

Prognostic Nomogram for Predicting Lower Extremity Deep Venous Thrombosis in Neurointensive Care Unit Patients: A Prospective Observational Study

“…First, the samples of the study were obtained from one tertiary hospital in Shanghai and so was limited as a single-center study. Second, data collection was performed before the COVID-19 pandemic; however, the latest study from the COVIDSurg Collaborative group demonstrated that SARS-CoV-2 infection was also a significant predictor of DVT in critically ill patients (24). Therefore, it will be more meaningful to explore the optimal prophylaxis and treatment protocols for DVT in combination with the above risk factors in the setting of the COVID-19 pandemic.…”