Matthias M Engelen1, Christophe Vandenbriele1, Tim Balthazar1, Eveline Claeys2, Jan Gunst3, Ipek Guler4, Marc Jacquemin5, Stefan Janssens1, Natalie Lorent2, Laurens Liesenborghs1,6, Kathelijne Peerlinck1, Griet Pieters1, Steffen Rex7,8, Pieter Sinonquel9, Lorenz Van der Linden10,11, Christine Van Laer12, Robin Vos13, Joost Wauters14, Alexander Wilmer14, Peter Verhamme1, Thomas Vanassche1. 1. Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium. 2. Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium. 3. Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium. 4. Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium. 5. Department of Cardiovascular Diseases and Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium. 6. The Outbreak Research Team, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium. 7. Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium. 8. Department of Cardiovascular Diseases, KU Leuven, Leuven, Belgium. 9. Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium. 10. Pharmacy Department, University Hospitals Leuven, Leuven, Belgium. 11. Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium. 12. Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium. 13. Department of CHROMETA, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium. 14. Medical Intensive Care, University Hospitals Leuven, Leuven, Belgium.
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. Thieme. All rights reserved.
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. Thieme. All rights reserved.
Authors: Anne-Marije Hulshof; Dionne C W Braeken; Chahinda Ghossein-Doha; Susanne van Santen; Jan-Willem E M Sels; Gerhardus J A J M Kuiper; Iwan C C van der Horst; Hugo Ten Cate; Bas C T van Bussel; Renske H Olie; Yvonne M C Henskens Journal: Res Pract Thromb Haemost Date: 2021-09-24