No Recurrence of VTE 1 Year after COVID-19-Associated VTE Event

A research letter found that patients hospitalized with COVID-19 who received anticoagulant therapy after diagnosis of venous thromboembolism (VTE) did not have a recurrence at 1 year. These findings were published in the journal Chest.

This prospective observational cohort study was conducted at the Lariboisière Hospital in France. Patients (N=59) hospitalized with COVID-19 who were diagnosed with VTE between March 2020 and April 2021 were evaluated for VTE recurrence at 1 year. VTE was defined as pulmonary embolism (PE) diagnosed by computed tomography pulmonary angiography or deep vein thrombosis (DVT) diagnosed by lower limb ultrasonography. Patients received initial anticoagulant therapy with low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) and were switched to 3 to 6 months direct oral anticoagulants at discharge.

Patients were aged median 62 (IQR, 52-67) years, 79% were men, BMI was 27.0 (IQR, 24.3-30.0), 35% had hypertension, 27% diabetes, 17% a history of cardiac disease, 12% a history of VTE, and 35% were critically ill with COVID-19.

More PE events were observed than DVT (83% vs 33%) and most patients received LMWH as first-line therapy (83%). At discharge, 73% received apixaban, 21% rivaroxaban, and 6% LMWH.

No recurrent VTE events were observed.

A 66-year-old patient with a history of ischemic cardiomyopathy presented with a non-ST-elevation myocardial infarction at 5 months after initiating apixaban and was switched to dual antiplatelet therapy.

Bleeding events occurred among 5 patients, 3 of whom had a major bleeding event affecting the gastrointestinal tract. One of the patients with a major bleeding event developed heparin-induced thrombocytopenia and was switched to argatroban followed by danaparoid and finally switched to apixaban.

After anticoagulation therapy was stopped, a 66-year-old patient with a history of polycythemia vera died at 9 months from major duodenal hemorrhage.

This study was limited by its small sample size and single center design and these findings may not be generalizable.

No recurrent VTE events at 1 year were observed among patients who had VTE during hospitalization for COVID-19.

“…our study with prospective 1-year follow-up supports the low VTE recurrence risk in either critically or non-critically ill COVID-19 patients with VTE while on anticoagulant therapy and 6 months after its discontinuation,” the study authors noted. “Our data remain to be confirmed in larger cohorts.”

Reference

Delrue M, Stépanian A, Voicu S, et al. No venous thromboembolic (VTE) recurrence after one-year follow-up of hospitalized COVID-19 patients diagnosed with VTE event: A prospective study. Chest. Published online April 7, 2022. doi:10.1016/j.chest.2022.03.043