Published: 6 April 2022
Authors: Maxime Delrue, MD, PhD Alain Stépanian, PhD Sebastian Voicu, MD, PhD Kladoum Nassarmadji, MD Damien Sène, MD, PhD Philippe Bonnin, MD, PhD Jean-Philippe Kevorkian, MD, PhD Pierre-Olivier Sellier, MD, PhD Jean-Michel Molina, MD, PhD Marie Neuwirth, MD Dominique Vodovar, MD, PhD Stéphane Mouly, MD, PhD Alexandre Mebazaa, MD, PhD Bruno Mégarbane, MD, PhD Virginie Siguret, PhD
Source: This abstract has been sourced from NZ Respiratory Research Review Issue 202
To the Editor: Since the beginning of the pandemic, a high prevalence of VTE has been observed in hospitalized patients with severe COVID-19. SARS-CoV-2 infection induces major endothelial cell dysfunction with systemic inflammatory response, both resulting in micro- and macrovascular thrombotic events that include pulmonary thrombosis/embolism. Although multiple studies have evaluated the efficacy and safety of anticoagulant therapy in patients with COVID-19 with diagnosed VTE during hospital stay, limited data are available regarding outcomes after hospital discharge. Notwithstanding the particular pathogenesis of thrombosis in patients with COVID-19, whether SARSCoV-2 infection is an effective transient VTE risk factor that requires 3 to 6 months of anticoagulant therapy is still debated. We aimed to investigate the outcome of patients with COVID-19 with diagnosed VTE during hospital stay while receiving anticoagulant therapy and after its discontinuation over 1-year follow-up evaluation.
Methods We conducted a prospective observational cohort study in our university hospital ICU and medical wards. We included all consecutive patients with COVID-19 with VTE diagnosed during hospitalization from March 25, 2020, to April 30, 2021, who were referred after hospital discharge to our outpatient thrombosis unit for follow-up. SARS-CoV-2 infection was diagnosed with the use of standard real-time polymerase chain reaction (Cobas-SARS-CoV-2 kits, Roche, France). COVID-19- related symptomatic VTE, namely pulmonary embolism (PE) and/or DVT, were diagnosed with CT pulmonary angiography and/or duplex ultrasound examination of the lower limb veins by certified ultrasound operators, respectively. Laboratory thrombophilia screening was performed within 24 h of DVT/ PE diagnosis (Table 1). VTE prophylaxis and management followed local guidelines in agreement with the international guidelines regarding ICU/non-ICU patients with COVID-19. In patients with DVT/PE, we recommended initial anticoagulant therapy with low-molecular-weight heparin (LMWH) or unfractionated heparin if contraindicated, which was changed on discharge to direct oral anticoagulant (DOAC; creatinine clearance $ 30 mL/min). For most patients, in the absence of evidence, a 3- to 6-month duration of anticoagulant treatment was proposed, as recommended elsewhere. Outcome criteria included symptomatic VTE recurrence (primary outcome) and bleeding event onset (secondary outcome). Visits were planned at 1, 3, 6, and 12 months after VTE diagnosis and beyond if needed. Periodic evaluation included physical examination to assess both outcomes and, when required, duplex ultrasound examination, CT pulmonary angiography, and laboratory reassessment of abnormal thrombophilia parameters if needed away from the acute phase. Bleeding events were adjudicated according to the International Society on Thrombosis and Haemostasis criteria. This study was part of the French COVID-19 cohort registry, approved by our institutional ethics committee (IDRCB-2020-A00256-33; CPP11-20-20.02.04.68737). All participating patients gave their written informed consent. Reporting of the study conforms to broad EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network guidelines. Quantitative variables were expressed as medians (25th to 75th percentiles), and categoric variables were expressed as percentages (version 11.0.1.0; MedCalc Software).
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