Factors Associated With Risk of Post-Discharge Thrombosis in Patients With COVID-19

COVID-19 is associated with a high incidence of thrombotic events; however, the need for extended thromboprophylaxis after hospitalization remains unclear.

Li, et al. (2021) sought to quantify the rate of post-discharge arterial and venous thromboembolism in patients with COVID-19, identify the factors associated with the risk of post-discharge venous thromboembolism, and evaluate the association of post-discharge anticoagulation use with venous thromboembolism incidence.

In this cohort study of 2832 adult patients hospitalized with COVID-19, the mean (SD) age was 63.4 (16.7) years (IQR, 53-75 years), and 1347 patients (47.6%) were men. Thirty-six patients (1.3%) had post-discharge venous thromboembolic events (16 pulmonary embolism, 18 deep vein thrombosis, and 2 portal vein thrombosis). Fifteen (0.5%) post-discharge arterial thromboembolic events were observed (1 transient ischemic attack and 14 acute coronary syndrome). The risk of venous thromboembolism decreased with time (Mann-Kendall trend test, P < .001), with a median (IQR) time to event of 16 (7-43) days. There was no change in the risk of arterial thromboembolism with time (Mann-Kendall trend test, P = .37), with a median (IQR) time to event of 37 (10-63) days. Patients with a history of venous thromboembolism (odds ratio [OR], 3.24; 95% CI, 1.34-7.86), peak dimerized plasmin fragment D (D-dimer) level greater than 3 μg/mL (OR, 3.76; 95% CI, 1.86-7.57), and pre-discharge C-reactive protein level greater than 10 mg/dL (OR, 3.02; 95% CI, 1.45-6.29) were more likely to experience venous thromboembolism after discharge. Prescriptions for therapeutic anticoagulation at discharge were associated with reduced incidence of venous thromboembolism (OR, 0.18; 95% CI, 0.04-0.75; P = .02).

Although extended thromboprophylaxis in unselected patients with COVID-19 is not supported, these findings suggest that post-discharge anticoagulation may be considered for high-risk patients who have a history of venous thromboembolism, peak D-dimer level greater than 3 μg/mL, and pre-discharge C-reactive protein level greater than 10 mg/dL, if their bleeding risk is low.

Reference: Li P, et al. Factors Associated With Risk of Post-discharge Thrombosis in Patients With COVID-19. JAMA Netw Open. 2021;4(11):e2135397. doi:10.1001/jamanetworkopen.2021.35397