Post-discharge thromboprophylaxis is not necessary.
Findings of a recent study indicated the rate of post-discharge hospital-associated venous thromboembolism (VTE) following hospitalization with coronavirus disease 2019 (COVID-19) is low.
The findings suggested empiric post-discharge thromboprophylaxis is not necessary, supporting the American College of Chest Physicians recommendation of not offering it.
Lara Roberts, MBBS, MD, MRCP, FRCPath, and colleagues reported the rates of post-discharge VTE and compared the rates with those following medical admission in the pre-COVID era. The team considered hospital-associated VTE as any VTE diagnosed during or following a medical admission of more than 48 hours or postoperatively and occurring up to 90 days of discharge.
The investigators used 2 hospital sites providing acute medical care. Both sites had VTE prevention programs incorporating documented VTE risk assessment of all patients on admission. A quality improvement program was incorporated with root-cause analysis of all episodes of hospital-associated VTE.
The VTE prevention team received an automated weekly list of all patients with any VTE imaging. The prevention team reviews all imaging reports to identify the ones confirming VTE and then cross-references with electronic health records to identify events meeting the criteria for the condition.
Roberts and the investigators noted all patients received information regarding VTE as part of their discharge summary which says, “A possible complication of being admitted to hospital is blood clots in the leg or the lung (deep vein thrombosis or pulmonary embolism). After going home, if you experience leg pain or swelling or any chest pain or breathlessness, you should seek medical advice.”
The investigators reported all hospital-associated VTE events associated with medical admission from March 3-May 7, 2020. Specifically, they followed post-discharge events following admission with COVID-19 diagnosed up until June 17—occurred within 6 weeks of previous admission.
Overall, there were 2863 COVID-19 admission and 84 hospital-associated VTE episodes. Of the episodes, 11% occurred post-discharge at a median of 8 days (range, 3-33 days). The proportion of patients who developed hospital-associated VTE was 4.8 per 1000 discharges (within 42 days of discharge).Among the patients, 2 had proximal deep vein thromboembolism and 7 experienced pulmonary embolisms.
There was 1 patient who required critical admission during a previous hospital stay, 8 received inpatient anticoagulant thromboprophylaxis, and 1 did not receive such treatment due to active bleeding.
During 2019, there were 85 hospital-associated VTE episodes among 18,159 hospital discharges. The OR for post-discharge hospital-associated VTE after hospitalization with COVID-19 was 1.6 (95% CI, .77-3.1; P=.2) compared with 2019 medical admissions. The OR only reached significance if the number of events was 50% higher in the COVID-19 cohort (OR, 2.4; 95% CI, 1.3-4.7). The OR did not change for a 10-25% increase in VTE event numbers in COVID only.
Overall incidence in the COVID-19 and 2019 medical admissions cohorts was lower than the rate of symptomatic VTE reported in the placebo arm of previous studies investigating extending thromboprophylaxis post-medical admission (1.2% to 1.7%).
The study, “Postdischarge venous thromboembolism following hospital admission with COVID-19,” was published online in the journal Blood.