Michael Dalager-Pedersen1,2, Lars Christian Lund3, Theis Mariager1, Rannva Winther1, Maja Hellfritzsch3,4, Torben Bjerregaard Larsen2,5, Reimar Wernich Thomsen6, Nanna Borup Johansen7, Ole Schmeltz Søgaard8, Stig Lønberg Nielsen9,10,11, Lars Haukali Omland12, Lene Fogt Lundbo13, Simone Bastrup Israelsen13, Zitta Barrella Harboe14, Anton Pottegård3, Henrik Nielsen1,2, Jacob Bodilsen1. 1. Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark. 2. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. 3. Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense C, Denmark. 4. Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus C, Denmark. 5. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. 6. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark. 7. Department of Clinical Evaluation and Biostatistics, Danish Medicines Agency, Copenhagen, Denmark. 8. Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark. 9. Department of Infectious Diseases, Odense University Hospital, Odense C, Denmark. 10. Research Unit for Infectious Diseases, Odense University Hospital, Odense, Denmark. 11. University of Southern Denmark, Odense, Denmark. 12. Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. 13. Center of Research & Disruption of Infectious Diseases (CREDID), Department of Infectious Diseases, Copenhagen University Hospitals, Hvidovre, Denmark. 14. Department of Pulmonary Medicine and Infectious Diseases, Copenhagen University Hospital North Zealand, Hillerød, Denmark.
Abstract
BACKGROUND: Venous thromboembolism (VTE) is a potentially fatal complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and thromboprophylaxis should be balanced against risk of bleeding. This study examined risks of VTE and major bleeding in hospitalized and community-managed SARS-CoV-2 patients compared with control populations. METHODS: Using nationwide population-based registries, 30-day risks of VTE and major bleeding in SARS-CoV-2 positive patients were compared with those of SARS-CoV-2 test-negative patients and with an external cohort of influenza patients. Medical records of all COVID-19 patients at 6 departments of infectious diseases in Denmark were reviewed in detail. RESULTS: The overall 30-day risk of VTE was 0.4% (40/9460) among SARS-CoV-2 patients (16% hospitalized), 0.3% (649/226 510) among SARS-CoV-2 negative subjects (12% hospitalized), and 1.0% (158/16 281) among influenza patients (59% hospitalized). VTE risks were higher and comparable in hospitalized SARS-CoV-2 positive (1.5%), SARS-CoV-2 negative (1.8%), and influenza patients (1.5%). Diagnosis of major bleeding was registered in 0.5% (47/9460) of all SARS-CoV-2 positive individuals and in 2.3% of those hospitalized. Medical record review of 582 hospitalized SARS-CoV-2 patients observed VTE in 4% (19/450) and major bleeding in 0.4% (2/450) of ward patients, of whom 31% received thromboprophylaxis. Among intensive care patients (100% received thromboprophylaxis), risks were 7% (9/132) for VTE and 11% (15/132) for major bleeding. CONCLUSIONS: Among people with SARS-CoV-2 infection in a population-based setting, VTE risks were low to moderate and were not substantially increased compared with SARS-CoV-2 test-negative and influenza patients. Risk of severe bleeding was low for ward patients, but mirrored VTE risk in the intensive care setting.
BACKGROUND: Venous thromboembolism (VTE) is a potentially fatal complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and thromboprophylaxis should be balanced against risk of bleeding. This study examined risks of VTE and major bleeding in hospitalized and community-managed SARS-CoV-2 patients compared with control populations. METHODS: Using nationwide population-based registries, 30-day risks of VTE and major bleeding in SARS-CoV-2 positive patients were compared with those of SARS-CoV-2 test-negative patients and with an external cohort of influenza patients. Medical records of all COVID-19 patients at 6 departments of infectious diseases in Denmark were reviewed in detail. RESULTS: The overall 30-day risk of VTE was 0.4% (40/9460) among SARS-CoV-2 patients (16% hospitalized), 0.3% (649/226 510) among SARS-CoV-2 negative subjects (12% hospitalized), and 1.0% (158/16 281) among influenza patients (59% hospitalized). VTE risks were higher and comparable in hospitalized SARS-CoV-2 positive (1.5%), SARS-CoV-2 negative (1.8%), and influenza patients (1.5%). Diagnosis of major bleeding was registered in 0.5% (47/9460) of all SARS-CoV-2 positive individuals and in 2.3% of those hospitalized. Medical record review of 582 hospitalized SARS-CoV-2 patients observed VTE in 4% (19/450) and major bleeding in 0.4% (2/450) of ward patients, of whom 31% received thromboprophylaxis. Among intensive care patients (100% received thromboprophylaxis), risks were 7% (9/132) for VTE and 11% (15/132) for major bleeding. CONCLUSIONS: Among people with SARS-CoV-2 infection in a population-based setting, VTE risks were low to moderate and were not substantially increased compared with SARS-CoV-2 test-negative and influenza patients. Risk of severe bleeding was low for ward patients, but mirrored VTE risk in the intensive care setting.
Authors: Lars Christian Lund; Jesper Hallas; Henrik Nielsen; Anders Koch; Stine Hasling Mogensen; Nikolai Constantin Brun; Christian Fynbo Christiansen; Reimar Wernich Thomsen; Anton Pottegård Journal: Lancet Infect Dis Date: 2021-05-10 Impact factor: 25.071
Authors: Frederick K Ho; Kenneth K C Man; Mark Toshner; Colin Church; Carlos Celis-Morales; Ian C K Wong; Colin Berry; Naveed Sattar; Jill P Pell Journal: Mayo Clin Proc Date: 2021-07-16 Impact factor: 7.616
Authors: Anton Pottegård; Lars Christian Lund; Øystein Karlstad; Jesper Dahl; Morten Andersen; Jesper Hallas; Øjvind Lidegaard; German Tapia; Hanne Løvdal Gulseth; Paz Lopez-Doriga Ruiz; Sara Viksmoen Watle; Anders Pretzmann Mikkelsen; Lars Pedersen; Henrik Toft Sørensen; Reimar Wernich Thomsen; Anders Hviid Journal: BMJ Date: 2021-05-05