Long‐term follow‐up of patients with venous thromboembolism and COVID‐19: Analysis of risk factors for death and major bleeding

Demelo‐Rodríguez, Pablo; Ordieres‐Ortega, Lucía; Ji, Zichen; del Toro‐Cervera, Jorge; de Miguel‐Díez, Javier; Álvarez‐Sala‐Walther, Luis A.; Galeano‐Valle, Francisco

INTRODUCTION: COVID‐19 predisposes patients to a higher risk of venous thromboembolism (VTE), although the extent of these implications is unclear and the risk of bleeding has been poorly evaluated. To date, no studies have reported long‐term outcomes of patients with COVID‐19 and VTE. METHOD: Prospective observational study to evaluate long‐term (90 days or more) outcomes of patients diagnosed with VTE (PE, DVT of the extremities, or both) in the setting of COVID‐19. The main outcome of the study was a compound of major bleeding and death. RESULTS: The study comprised 100 patients (mean age 65 ± 13.9 years). At the time of VTE diagnosis, 66% patients were hospitalized, 34.8% of them in the ICU. Mean follow‐up was 97.9 ± 23.3 days. During the study period, 24% patients died and median time to death was 12 (IQR: 2.25‐20.75) days, 11% patients had major bleeding and median time to event was 12 (IQR: 5‐16) days. The cause of death was PE in 5% and bleeding in 2% of patients. There were no VTE recurrences. The main study outcome occurred in 29% patients. Risk of death or major bleeding was independently associated with ICU admission (HR 12.2; 95% CI 3.0‐48.3), thrombocytopenia (HR 4.5; 95% CI 1.2‐16.5), and cancer (HR 21.6; 95% CI 1.8‐259). CONCLUSION: In patients with COVID‐19 and VTE, mortality and major bleeding were high and almost a third of deaths were VTE‐related. The majority of complications occurred in the first 30 days. ICU admission, thrombocytopenia, and cancer are risk factors for poor prognosis.