Some hospitalized COVID-19 patients may need anticoagulation therapy at discharge
Some hospitalized COVID-19 patients may need to begin anticoagulation (AC) therapy after discharge to combat the risk of venous thromboembolism (VTE), according to new findings published in JAMA Network Open.
“Universal prescription of postdischarge AC in patients with COVID-19 offers marginal clinical benefits and may cause harm in patients at high risk of bleeding,” wrote lead author Pin Li, PhD, a specialist with the Henry Ford Health System in Michigan, and colleagues. “Given the unclear evidence, clinicians are facing the dilemma of which patients hospitalized with COVID-19 could benefit from postdischarge AC.”
The study’s authors explored data from more than 2,800 adult patients hospitalized with COVID-19 from March 2020 to November 2020. All patients were treated at one of five hospitals belonging to a single U.S. health system. The mean patient age was 63.4 years old, and 52.4% of patients were women.
Overall, VTE was seen in 1.3% of patients following hospital discharge. This included 16 patients with pulmonary embolism, 18 patients with deep vein thrombosis and 2 patients with portal vein thrombosis. The median time to a VTE was 16 days, and that risk decreased as time went on.
In addition, arterial thromboembolism (ATE) was seen in 0.5% of patients after discharge. This included one case of transient ischemic attack and 14 cases of acute coronary syndrome. The median time to an ATE was 37 days.
After adjusting for other variables, a history of VTE, C-reactive protein levels greater than 10 mg/dL before discharge and peak D-dimer levels greater than 3 μg/mL were all associated with a higher risk of VTE. Any patients with these risk factors, the authors wrote, should be considered for AC therapy if they face a low bleeding risk.
“Our study has reiterated the low incidence of symptomatic VTE in patients with COVID-19 after discharge, which was comparable to other studies,” the authors wrote. “To our knowledge, this study is the first so far that has captured enough postdischarge VTE events to be able to identify the factors associated with increased risk.”
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.