Incidence of Venous Thromboembolism in Patients Discharged After COVID-19 Hospitalisation
On Monday, Matthias M. Engelen of University Hospitals Leuven in Leuven, Belgium, presented late-breaking results evaluating the residual thrombotic risk and incidence of venous thromboembolism (VTE) in patients following hospitalization for COVID-19. In hospitalized patients with COVID-19, D-dimer levels are often high and a predictor of mortality, with an incidence of VTE up to 30%-50%. In Leuven, thromboprophylaxis with a prophylactic or intermediate dose of low molecular weight heparins (LMWHs) has become the standard of care for COVID-19 patients. However, little is known about the incidence of COVID-19–associated VTE after discharge. Engelen stated that D-dimers were measured and venous ultrasound screening (VUS) performed at a multidisciplinary outpatient follow-up six weeks after discharge. In patients who were hospitalized in an intensive care unit (ICU) or had D-dimer levels ≥2,000 ng/mL, CT pulmonary angiogram (CTPA) or ventilation/perfusion lung scan (V/Q) was performed, excluding patients with known VTE.
As Engelen reported, to date, they analyzed 102 patients with a mean age of 57 years. Twenty-six patients were hospitalized in ICU with a mean stay of 10 days, 44% requiring mechanical ventilation. Follow-up took place 44 days after hospital discharge. Mean D-dimer levels were significantly lower at follow-up (593 ng/mL) compared with discharge (1,101 ng/mL) and at the highest value during hospitalization (2,618 ng/mL). Only 8% of patients received prophylactic LMWHs after discharge without major or clinically relevant bleedings. There were no symptomatic VTE cases, as systematic screening with VUS with or without CTPA or V/Q revealed only one asymptomatic VTE.
Engelen concluded from these findings that extended thromboprophylaxis after hospitalization is not routinely needed, as an extremely low incidence of VTE in COVID-19 patients was observed after hospitalization.
Read the full abstract here.