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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    *
1   Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
,
Christophe Vandenbriele   *
1   Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
,
Tim Balthazar
1   Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
,
Eveline Claeys
2   Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
,
Jan Gunst
3   Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
,
Ipek Guler
4   Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
,
Marc Jacquemin
5   Department of Cardiovascular Diseases and Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
,
Stefan Janssens
1   Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
,
Natalie Lorent
2   Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
,
Laurens Liesenborghs
1   Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
6   The Outbreak Research Team, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
,
Kathelijne Peerlinck
1   Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
,
Griet Pieters
1   Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
,
Steffen Rex
7   Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
8   Department of Cardiovascular Diseases, KU Leuven, Leuven, Belgium
,
Pieter Sinonquel
9   Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
,
Lorenz Van der Linden
10   Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
11   Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
,
Christine Van Laer
12   Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
,
Robin Vos
13   Department of CHROMETA, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
,
Joost Wauters
14   Medical Intensive Care, University Hospitals Leuven, Leuven, Belgium
,
Alexander Wilmer
14   Medical Intensive Care, University Hospitals Leuven, Leuven, Belgium
,
Peter Verhamme
1   Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
,
Thomas Vanassche
1   Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
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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

* Contributed equally.




Publication History

Article published online:
23 April 2021

© 2021. Thieme. All rights reserved.

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