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 Verhamme; Thomas Vanassche

doi:10.1055/s-0041-1727284

Seminars in Thrombosis and Hemostasis, Table of Contents

Semin Thromb Hemost 2021; 47(04): 362-371
DOI: 10.1055/s-0041-1727284

Review Article

Venous Thromboembolism in Patients Discharged after COVID-19 Hospitalization

Matthias M. Engelen ^*

¹Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium

,

Christophe Vandenbriele^*

¹Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium

,

Tim Balthazar

¹Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium

,

Eveline Claeys

²Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium

,

Jan Gunst

³Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium

,

Ipek Guler

⁴Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium

,

Marc Jacquemin

⁵Department of Cardiovascular Diseases and Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium

,

Stefan Janssens

¹Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium

,

Natalie Lorent

²Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium

,

Laurens Liesenborghs

¹Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium

⁶The Outbreak Research Team, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium

,

Kathelijne Peerlinck

¹Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium

,

Griet Pieters

¹Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium

,

Steffen Rex

⁷Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium

⁸Department of Cardiovascular Diseases, KU Leuven, Leuven, Belgium

,

Pieter Sinonquel

⁹Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium

,

Lorenz Van der Linden

¹⁰Pharmacy Department, University Hospitals Leuven, Leuven, Belgium

¹¹Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium

,

Christine Van Laer

¹²Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium

,

Robin Vos

¹³Department of CHROMETA, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium

,

Joost Wauters

¹⁴Medical Intensive Care, University Hospitals Leuven, Leuven, Belgium

,

Alexander Wilmer

¹⁴Medical Intensive Care, University Hospitals Leuven, Leuven, Belgium

,

Peter Verhamme

¹Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium

,

Thomas Vanassche

¹Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium

› Author Affiliations

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.

Keywords

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

Full Text

References

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