key: cord-0749797-zdw84xzj
authors: Spyropoulos, Alex C.; Giannis, Dimitrios; Goldin, Mark
title: Vascular thromboembolic events following COVID‐19 hospital discharge: Incidence and risk factors
date: 2021-06-27
journal: Res Pract Thromb Haemost
DOI: 10.1002/rth2.12547
sha: 307aaa803e18ee3a8efd2752b8dfdea1f7b1a99c
doc_id: 749797
cord_uid: zdw84xzj

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We read with interest the retrospective cohort study by Eswaran et al 1 Interestingly, the authors described this 2.0% thrombotic incidence as "low."

The American College of Chest Physicians has previously defined a threshold symptomatic thrombotic risk of 1.0% in control groups to define an "at-VTE" or "moderate-VTE" risk hospitalized medically ill population that would benefit from pharmacologic thromboprophylaxis. 2 Although it should be acknowledged that the rate of symptomatic pulmonary emboli in the study by Eswaran et al 1 was ≈0.7%, nearly half of the population had received postdischarge thromboprophylaxis. In addition, applying the criteria used by the authors to define a 2.0% symptomatic thrombotic incidence as "low risk," no hospitalized medically ill patient-including those with pneumonia and sepsis-would in theory benefit from in-hospital pharmacologic thromboprophylaxis, as the incidence of symptomatic VTE seen in control groups in the early pivotal trials of thromboprophylaxis in hospitalized medically ill patients was ≈1.5%. 3 This would likely apply to hospitalized patients with COVID-19 as well, as the incidence of symptomatic VTE seen in larger cohorts from later studies approached "only" 2.9%. 4 Finally, there is now good-quality data that indicate that postdischarge thromboprophylaxis reduces the incidence of ATEs (especially stroke) in hospitalized medically ill populations, and that it is worthwhile to combine ATE and VTE rates in hospitalized medically ill patients when assessing thrombotic risk in developing a postdischarge extended thromboprophylactic strategy. 5 Our group recently presented a large prospective registry of postdischarge thromboembolic and mortality outcomes of 4906 hospitalized patients with COVID-19. 6 Similar to the findings of Eswaran et al, 1 we found a 90-day rate of VTE of 1.55%, an ATE rate of 1.71%, and an all-cause mortality rate of 4.83. Receipt of postdischarge anticoagulants, mostly prophylactic-dose direct oral anticoagulants, reduced the risk of major thromboembolism and all-cause mortality by 46%. Nonetheless, unlike the present authors, we did not describe these thrombotic rates as "low risk" but rather "at risk" as supported by antithrombotic guideline thresholds. Minimizing these substantial risks could result in foreclosing opportunities to assess and promote additional or expanded benefits of extended post-hospital discharge thromboprophylaxis in hospitalized patients with COVID-19.

Thrombosis.

Vascular thromboembolic events following COVID-19 hospital discharge: incidence and risk factors

Prevention of venous thromboembolism

Metaanalysis: anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized medical patients

Prevalence and predictors of venous thromboembolism or mortality in hospitalized COVID-19 patients

Extended-duration betrixaban reduces the risk of stroke versus standard-dose enoxaparin among hospitalized medically ill patients: an APEX trial substudy (acute medically ill venous thromboembolism prevention with extended duration betrixaban)

Thromboembolic Outcomes of Hospitalized COVID-19 Patients in the 90-Day Post-Discharge Period: Early Data from the Northwell CORE-19 Registry. ASH; 2020