Timing of venous thromboembolism diagnosis in hospitalized and non-hospitalized patients with COVID-19

Abstract

Background: The reported incidence of venous thromboembolism (VTE) in COVID-19 patients varies widely depending on patient populations sampled and has been predominately studied in hospitalized patients. The goal of this study was to assess the evolving burden of COVID-19 and the timing of associated VTE events in a systemswide cohort. Methods: COVID-19 PCR positive hospitalized and non-hospitalized patients ≥18 years of age tested between 1/ 1/2020 through 12/31/2020 were retrospectively analyzed using electronic medical records from multiple states across the Mayo Clinic enterprise. Radiology reports within 90 days before and after confirmed COVID-19 diagnosis were examined for VTE outcomes using validated Natural Language Processing (NLP) algorithms. Results: A 29-fold increased rate of VTE compared to the pre-COVID-19 period was noted during the first week following the first positive COVID-19 test (RR: 29.39; 95% CI 21.77-40.03). The rate of VTE steadily decreased and returned to baseline by the 6th week. Among 366 VTE events, most occurred during (n = 243, 66.3%) or after (n = 111, 30.3%) initial hospitalization. Only 11 VTE events were identified in patients who did not require hospitalization (3.0% of total VTE events). VTE and mortality increased with advancing age with a pronounced increased each decade in older patients. Conclusion:We observed a profoundly increased risk of VTE within the first week after positive testing for COVID-19 that returned to baseline levels after 6 weeks. VTE events occurred almost exclusively in patients who were hospitalized, with the majority of VTE events identified within the first days of hospitalization.

Risk of venous thromboembolism after COVID‐19 vaccination

“…VTE was defined as upper or lower extremity deep vein thrombosis (DVT; proximal and distal) and pulmonary embolism (PE) and were analyzed from radiology text reports using highly accurate, previously validated natural language processing (NLP) algorithms. 1 , 8 VTE events within the 90 days after vaccination were compared to events occurring in the 90‐day window before vaccination using reversed person‐time analysis and the Kaplan‐Meier method. For patients with DVT and PE, the first event in each timeframe in closest proximity to the index date was used for the time to event analysis.…”

“…Thromboembolic events were extracted from the electronic medical record in the 90 days before and after the index date through December 9, 2021. VTE was defined as upper or lower extremity deep vein thrombosis (DVT; proximal and distal) and pulmonary embolism (PE) and were analyzed from radiology text reports using highly accurate, previously validated natural language processing (NLP) algorithms 1,8 . VTE events within the 90 days after vaccination were compared to events occurring in the 90‐day window before vaccination using reversed person‐time analysis and the Kaplan‐Meier method.…”

“…Vaccine safety beyond the initial clinical trials has been a major area of focus to maintain public trust and encourage high rates of vaccination. COVID‐19 infection itself is known to significantly increase short‐term venous thromboembolism (VTE) 1 risk. In early 2021 reports of a rare thrombotic complication (vaccine‐induced immune thrombotic thrombocytopenia [VITT] 2 ) were observed with the ChAdOx1 nCov‐19 (AstraZeneca) vaccine, 3 , 4 , 5 which ultimately led many European nations to temporarily pause administration of this vaccine in March of 2021 for further review.…”

The association of acute COVID‐19 infection with Patient Safety Indicator‐12 events in a multisite healthcare system

“…COVID-19 dysregulated host response leads to an increased risk of VTE in many patients. 5,15 A study by Pasha et al 16 The eight cases illustrate several critiques of the PSI-12 measure, including some that existed prior to the COVID-19 pandemic. 18 PSI-12 aims to evaluate perioperative VTE, but the broad list of procedural codes included also identifies many patients admitted for urgent medical needs who required a secondary surgical procedure.…”

Post-Pulmonary Embolism Syndrome and Functional Outcomes after Acute Pulmonary Embolism

“…Most COVID-19-associated VTE events occur in patients during hospitalization or after hospitalization, and only a small proportion of the patients treated at home are tested for the presence of VTE. 128 Since they were never subjected to CTPA, a substantial number of these patients may have experienced undiagnosed VTE. Although long-term follow-up studies after COVID-19-associated PE are currently unavailable, the results of two studies may support a higher than expected incidence of CTEPH.…”