Abstract Number: LB/CO01.3
Meeting: ISTH 2020 Congress
Background: Coronavirus (SARS-CoV-2) induced pneumonia (COVID-19) is associated with a pro-thrombotic state. In hospitalised patients with COVID-19, D-dimer levels are often high and a predictor of mortality, with an incidence of venous thromboembolism (VTE) up to 30-50%. Therefore, thromboprophylaxis with prophylactic or intermediate dose of low molecular weight heparins (LMWHs) became the standard of care for COVID-19 patients at our institution. However, little is known about the incidence of COVID-19 associated VTE after discharge.
Aims: To evaluate the residual thrombotic risk and incidence of VTE in patients following hospitalisation for COVID-19.
Methods: In COVID-19 patients, we measured D-dimers and performed venous ultrasound screening (VUS) at a multidisciplinary outpatient follow-up 6 weeks after discharge. In patients who were hospitalised on an intensive care unit (ICU) or had D-dimer levels ≥2000 ng/mL, CT pulmonary angiogram (CTPA) or ventilation/perfusion lung scan (V/Q) was performed. Patients with known VTE were excluded. The study was approved by the ethical committee.
Results: So far, we analysed 102 patients with a mean age of 57 years (SD 12.4). Twenty-six patients were hospitalised at ICU with a mean stay of 10 days (SD 6.4); 44% of which required mechanical ventilation. Follow-up took place 44 days (SD 9.5) after hospital discharge. Mean D-dimer levels were significantly lower at follow-up (593 ng/mL) compared to discharge (1101 ng/mL) and to the highest value during hospitalisation (2618 ng/mL) (figure). Only 8% of patients received prophylactic LMWHs after discharge (mean 13 days) without major or clinically relevant bleedings. There were no symptomatic VTE cases. Systematic screening with VUS with or without CTPA or V/Q revealed only one asymptomatic VTE (deep vein thrombosis) (0.98%).
Conclusions: We report a very low incidence of VTE (< 1%) in COVID-19 patients after hospitalisation, supported by a significant decrease in D-dimers. These results suggest that extended thromboprophylaxis after hospitalisation is not routinely needed.
[In-hospital D-dimer values compared to outpatient follow-up values]
To cite this abstract in AMA style:Engelen MM, Vanassche T, Balthazar T, Claeys E, Gunst J, Jacquemin M, Janssens S, Lorent N, Liesenborghs L, Peerlinck K, Pieters G, Rex S, Sinonquel P, Van der Linden L, Van Laer C, Vos R, Wauters J, Wilmer A, Verhamme P, Vandenbriele C. Incidence of Venous Thromboembolism in Patients Discharged after COVID-19 Hospitalisation [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/incidence-of-venous-thromboembolism-in-patients-discharged-after-covid-19-hospitalisation/. Accessed August 15, 2020.
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