Thromboembolic events including venous thromboembolism (VTE), arterial thromboembolism (ATE), and mortality from sub-clinical thrombotic events occur frequently in COVID-19 inpatients. Whether the risk extends post-discharge has been controversial. Our prospective registry included consecutive COVID-19 patients hospitalized within our multihospital system from March 1st - May 31st 2020. We captured demographics, comorbidities, laboratory parameters, medications, post-discharge thromboprophylaxis, and 90-day outcomes. Data from electronic health records, health informatics exchange, a radiology database, and telephonic follow-up were merged. The primary outcome was a composite of adjudicated VTE, ATE, and all-cause mortality (ACM). The principal safety outcome was major bleeding (MB). Among 4,906 patients (53.7% male) mean age was 61.7 years. Comorbidities included hypertension (38.6%), diabetes (25.1%), obesity (18.9%), and cancer history (13.1%). Post-discharge thromboprophylaxis was prescribed in 13.2%. VTE rate was 1.55%, ATE 1.71%, ΑCM 4.83%, and MB 1.73%. The composite primary outcome rate was 7.13% and was significantly associated with advanced age (OR: 3.66, 95%CI: 2.84-4.71), prior VTE (OR: 2.99, 95%CI: 2.00-4.47), ICU stay (OR: 2.22, 95%CI: 1.78-2.93), chronic kidney disease (CKD) (OR: 2.10, 95%CI: 1.47-3.0), peripheral arterial disease (OR: 2.04, 95%CI: 1.10-3.80), carotid occlusive disease (OR: 2.02, 95%CI: 1.30-3.14), IMPROVE-DD VTE score ≥4 (OR: 1.51, 95%CI: 1.06-2.14), and coronary artery disease (OR: 1.50, 95%CI: 1.04-2.17). Post-discharge anticoagulation was significantly associated with reducing the primary outcome (OR: 0.54, 95%CI: 0.47-0.81). Post-discharge VTE, ATE, and ACM occur frequently following COVID-19 hospitalization. Advanced age, cardiovascular risk factors, CKD, IMPROVE-DD VTE score ≥4, and ICU stay increase risk. Post-discharge anticoagulation reduced risk by 46%.
Dimitrios Giannis, Steven Allen, James Tsang, Sarah Flint, Tamir Pinhasov, Stephanie Williams, Gary Tan, Richa Thakur, Christian Leung, Matthew Salvatore Snyder, Chirag Bhatia, David Garrett, Christina Cotte, Shelby Isaacs, Emma Gugerty, Anne Davidson, Galina S Marder, Austin Schnitzer, Bradley Goldberg, Thomas McGinn, Karina Davidson, Matthew A Barish, Michael Qiu, Meng Zhang, Mark Goldin, Miltiadis Matsagkas, Eleni Markos Arnaoutoglou, Alex C Spyropoulos, Covid-Research Consortium Northwell Health