Journal article
Venous thromboembolism (VTE) prevention and diagnosis in COVID-19: Practice patterns and outcomes at 33 hospitals
PloS one, Vol.17(5), e0266944
2022
DOI: 10.1371/journal.pone.0266944
PMCID: PMC9071149
PMID: 35511940
Abstract
Early reports of increased thrombosis risk with SARS-CoV-2 infection led to changes in venous thromboembolism (VTE) management. Real-world data on the prevalence, efficacy and harms of these changes informs best practices.
Define practice patterns and clinical outcomes related to VTE diagnosis, prevention, and management in hospitalized patients with coronavirus disease-19 (COVID-19) using a multi-hospital US sample.
In this retrospective cross-sectional study of 1121 patients admitted to 33 hospitals, exposure was dose of anticoagulant prescribed for VTE prophylaxis (standard, intensified, therapeutic), and primary outcome was VTE (pulmonary embolism [PE] and deep vein thrombosis [DVT]); secondary outcomes were PE, DVT, arterial thromboembolism (ATE), and bleeding events. Multivariable logistic regression models accounting for clustering by site and adjusted for risk factors were used to estimate odds ratios (ORs). Inverse probability weighting was used to account for confounding by indication.
1121 patients (mean age 60 ± 18, 47% female) admitted with COVID-19 between February 2, 2020 and December 31, 2020 to 33 US hospitals were included. Pharmacologic VTE prophylaxis was prescribed in 86%. Forty-seven patients (4.2%) had PE, 51 (4.6%) had DVT, and 23 (2.1%) had ATE. Forty-six patients (4.1%) had major bleeding and 46 (4.1%) had clinically relevant non-major bleeding. Compared to standard prophylaxis, adjusted odds of VTE were 0.67 (95% CI 0.21-2.1) with no prophylaxis, 1.0 (95% CI 0.06-17) with intensified, and 3.0 (95% CI 0.89-10) with therapeutic. Adjusted odds of bleeding with no prophylaxis were 5.6 (95% CI 3.0-11) and 5.3 (95% CI 3.0-10) with therapeutic (no events on intensified dosing).
Therapeutic anticoagulation was associated with a 3-fold increased odds of VTE and 5-fold increased odds of bleeding. While higher bleeding rates with high-intensity prophylaxis were likely due to full-dose anticoagulation, we conclude that high thrombosis rates were due to clinical concern for thrombosis before formal diagnosis.
Details
- Title: Subtitle
- Venous thromboembolism (VTE) prevention and diagnosis in COVID-19: Practice patterns and outcomes at 33 hospitals
- Creators
- Anna L Parks - University of UtahAndrew D Auerbach - University of California, San FranciscoJeffrey L Schnipper - Brigham and Women's HospitalAmanda Bertram - Society of Hospital MedicineSun Y Jeon - San Francisco VA Medical CenterBridget Boyle - Society of Hospital MedicineMargaret C Fang - University of California, San FranciscoShrirang M Gadrey - University of VirginiaZishan K Siddiqui - Society of Hospital MedicineDaniel J Brotman - Society of Hospital MedicineHospital Medicine Reengineering Network (HOMERuN)
- Contributors
- Ethan Kuperman (Contributor) - University of Iowa, General Internal Medicine
- Resource Type
- Journal article
- Publication Details
- PloS one, Vol.17(5), e0266944
- DOI
- 10.1371/journal.pone.0266944
- PMID
- 35511940
- PMCID
- PMC9071149
- NLM abbreviation
- PLoS One
- ISSN
- 1932-6203
- eISSN
- 1932-6203
- Grant note
- DOI: 10.13039/100000049, name: National Institute on Aging, award: R03AG074074; DOI: 10.13039/100000050, name: National Heart, Lung, and Blood Institute, award: K24HL141354; DOI: 10.13039/100000936, name: Gordon and Betty Moore Foundation; DOI: 10.13039/100002491, name: Bristol-Myers Squibb; name: Johns Hopkins Hospitalist Scholars Fund
- Language
- English
- Date published
- 2022
- Academic Unit
- General Internal Medicine; Internal Medicine
- Record Identifier
- 9984359787902771
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