Venous thromboembolism in patients discharged after COVID-19 hospitalization

Matthias M. Engelen, Christophe Vandenbriele, Tim Balthazar, Eveline Claeys, Jan Gunst, Ipek Guler, Marc Jacquemin, Stefan Janssens, Natalie Lorent, Laurens Liesenborghs, Kathelijne Peerlinck, Griet Pieters, Steffen Rex, Pieter Sinonquel, Lorenz Van der Linden, Christine Van Laer, Robin Vos, Joost Wauters, Alexander Wilmer, Peter VerhammeThomas Vanassche

Research output: Contribution to journalA1: Web of Science-article

Abstract

Background Venous thromboembolism (VTE) is a frequent complication of COVID-19, so that the importance of adequate in-hospital thromboprophylaxis in patients hospitalized with COVID-19 is well established. However, the incidence of VTE after discharge and whether postdischarge thromboprophylaxis is beneficial and safe are unclear. In this prospective observational single-center study, we report the incidence of VTE 6 weeks after hospitalization and the use of postdischarge thromboprophylaxis.

Methods Patients hospitalized with confirmed COVID-19 were invited to a multidisciplinary follow-up clinic 6 weeks after discharge. D-dimer and C-reactive protein were measured, and all patients were screened for deep vein thrombosis with venous duplex-ultrasound. Additionally, selected high-risk patients received computed tomography pulmonary angiogram or ventilation-perfusion (V/Q) scan to screen for incidental pulmonary embolism.

Results Of 485 consecutive patients hospitalized from March through June 2020, 146 patients were analyzed, of which 39% had been admitted to the intensive care unit (ICU). Postdischarge thromboprophylaxis was prescribed in 28% of patients, but was used more frequently after ICU stay (61%) and in patients with higher maximal D-dimer and C-reactive protein levels during hospitalization. Six weeks after discharge, elevated D-dimer values were present in 32% of ward and 42% of ICU patients. Only one asymptomatic deep vein thrombosis (0.7%) and one symptomatic pulmonary embolism (0.7%) were diagnosed with systematic screening. No bleedings were reported.

Conclusion In patients who had been hospitalized with COVID-19, systematic screening for VTE 6 weeks after discharge revealed a low incidence of VTE. A strategy of selectively providing postdischarge thromboprophylaxis in high-risk patients seems safe and potentially effective.

Original languageEnglish
JournalSeminars in Thrombosis and Hemostasis
Number of pages10
ISSN0094-6176
DOIs
Publication statusPublished - 2021

Keywords

  • venous thromboembolism
  • deep vein thrombosis
  • pulmonary embolism
  • COVID-19
  • SARS-CoV-2
  • anticoagulation
  • thromboprophylaxis after discharge
  • postdischarge thromboprophylaxis

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