VTE Recurrence Risk Low in COVID-19 Patients After Discharge

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No recurrence of venous thromboembolic events appeared after 1 year in patients who experienced these events while hospitalized with severe COVID-19, based on data from 48 individuals.

A high prevalence of venous thromboembolic events (VTEs) has been noted in COVID-19 patients hospitalized with severe disease, but data on long-term outcomes for these patients are limited, and whether COVID-19 is a transient risk factor for VTE remains unclear, write Maxime Delrue, MD, PhD, from the University of Paris, France, and colleagues.

In a prospective, observational study published in the journal CHEST, the researchers analyzed data from 48 consecutive adult patients who developed VTE related to COVID-19 during a hospital stay between March 2020, and April 2021, at a single center. The median follow-up was 12 months, including 6 months after discontinuation of anticoagulants. The average age of the patients was 62 years, and 38 patients were men.

VTE was defined as pulmonary embolism (PE) and/or deep vein thrombosis (DVT), and was reported in 40 patients and 8 patients, respectively. The primary outcome was recurrence of VTE, and the secondary outcome was the onset of a bleeding event. Patients had scheduled follow-up visits at 1,3, 6, and 12 months after their initial VTE diagnoses.

Overall, no instances of symptomatic VTE recurrence were noted after hospital discharge either during or after use of anticoagulants. A total of 5 patients (11%) presented with bleeding during the anticoagulant use period; three of these were major gastrointestinal hemorrhages (two in-hospital and one after discharge) and two were minor episodes that occurred after discharge. The rate of major bleeding was similar to those reported in previous studies, the researchers said. Most of the patients (83%) were given low-molecular-weight heparin as an initial anticoagulant, whereas 13% received a direct oral anticoagulant and 4% received unfractionated heparin.

"This low risk in COVID-19 patients is similar to what is observed in patients with VTE provoked by a transient nonsurgical factor," they note in their discussion.

The study findings were limited by several factors, including the single-center design and small sample size, but strengthened by the inclusion of both critically ill and noncritically ill COVID-19 patients and outcomes reported after relatively long-term discontinuation of anticoagulant therapy, the researchers noted.

Although additional research in larger cohorts is needed, the results support the low risk of VTE recurrence in COVID-19 patients with VTE, and a limited duration of anticoagulant therapy in agreement with current guidelines for most patients, they concluded.

The study received no outside funding. The researchers have disclosed no relevant financial relationships.

CHEST. Published April 7, 2022. Full text

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