Incidence of symptomatic venous thromboembolism following hospitalization for coronavirus disease 2019: Prospective results from a multi-center study

Rashidi, Farid; Barco, Stefano; Kamangar, Farin; Heresi, Gustavo A.; Emadi, Ashkan; Kaymaz, Cihangir; Jansa, Pavel; Reis, Abilio; Rashidi, Arash; Taghizadieh, Ali; Rezaeifar, Parisa; Moghimi, Minoosh; Ghodrati, Samad; Mozafari, Abolfazl; Foumani, Ali Alavi; Tahamtan, Ouria; Rafiee, Effat; Abbaspour, Zahra; Khodadadi, Kasra; Alamdari, Golsa; Boodaghi, Yasman; Rezaei, Maryam; Muhammadi, Muhammad Javad; Abbasi, Meysam; Movaseghi, Fatemeh; Koohi, Ata; Shakourzad, Leila; Ebrahimi, Fatemeh; Radvar, Sarvin; Amoozadeh, Maryam; Fereidooni, Fatemeh; Naseari, Hanieh; Movalled, Kobra; Ghorbani, Ozra; Ansarin, Khalil

BACKGROUND: Thrombosis and pulmonary embolism appear to be major causes of mortality in hospitalized coronavirus disease 2019 (COVID-19) patients. However, few studies have focused on the incidence of venous thromboembolism (VTE) after hospitalization for COVID-19. METHODS: In this multi-center study, we followed 1529 COVID-19 patients for at least 45 days after hospital discharge, who underwent routine telephone follow-up. In case of signs or symptoms of pulmonary embolism (PE) or deep vein thrombosis (DVT), they were invited for an in-hospital visit with a pulmonologist. The primary outcome was symptomatic VTE within 45 days of hospital discharge. RESULTS: Of 1529 COVID-19 patients discharged from hospital, a total of 228 (14.9%) reported potential signs or symptoms of PE or DVT and were seen for an in-hospital visit. Of these, 13 and 12 received Doppler ultrasounds or pulmonary CT angiography, respectively, of whom only one patient was diagnosed with symptomatic PE. Of 51 (3.3%) patients who died after discharge, two deaths were attributed to VTE corresponding to a 45-day cumulative rate of symptomatic VTE of 0.2% (95%CI 0.1%–0.6%; n = 3). There was no evidence of acute respiratory distress syndrome (ARDS) in these patients. Other deaths after hospital discharge included myocardial infarction (n = 13), heart failure (n = 9), and stroke (n = 9). CONCLUSIONS: We did not observe a high rate of symptomatic VTE in COVID-19 patients after hospital discharge. Routine extended thromboprophylaxis after hospitalization for COVID-19 may not have a net clinical benefit. Randomized trials may be warranted.