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COVID-19 Tied to High Risk of Thrombotic Events

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COVID-19 was associated with a greater risk for a host of thrombotic events in the months following a patient’s infection, a large study in Sweden found.

Among over 1 million people who tested positive for COVID-19 in the past month, risk for a first pulmonary embolism was 33 times higher compared with a matched control group, after adjusting for multiple potential confounders (risk ratio [RR] 33.05, 95% CI 32.8-33.3), reported Anne-Marie Fors Connolly, MD, PhD, of Umeå University in Sweden, and colleagues.

Meanwhile, the risk for a first deep vein thrombosis was five times higher (RR 4.98, 95% CI 4.96-5.01) and the risk for bleeding was nearly twice as high (RR 1.88, 95% CI 1.71-2.07), according to their findings in The BMJ.

“This study found an increased risk of a first deep vein thrombosis up to three months after COVID-19, pulmonary embolism up to six months, and a bleeding event up to two months,” the group wrote. “We found an excess risk of outcomes in patients with more severe COVID-19 admitted to hospital, but especially in those admitted to an intensive care unit.”

Cardiovascular complications have been an increasing concern after SARS-CoV-2 infection, but prior studies have shown conflicting results on the risk of venous thromboembolism, the group noted.

“Our findings arguably support thromboprophylaxis to avoid thrombotic events, especially for high-risk patients,” the authors concluded.

Fors Connolly told MedPage Today by email that “a surprising finding is that mild COVID-19 patients” — those in the study who did not need hospitalization — “did not have an increased risk of bleeding compared to the matched background control individuals.”

In an accompanying editorial, Frederick Ho, PhD, and Jill Pell, MD, both of the University of Glasgow in Scotland, stated that “since risks of thromboembolism and bleeding were highest among participants with more severe COVID-19, vaccination could reduce the overall risk both by preventing infection and by reducing its severity when it does occur.”

They pointed out that the findings are still relevant now that 65% of the world is vaccinated, since breakthrough infections occur and vaccine effectiveness has reduced with Omicron and over time.

As governments shift their focus to living with COVID, noted Ho and Pell, the current study “reminds us of the need to remain vigilant to the complications associated with even mild SARS-CoV-2 infection, including thromboembolism.”

Fors Connolly and colleagues examined data on 1,057,174 individuals with a first SARS-CoV-2 infection from Feb. 1, 2020 to May 25, 2021 in SmiNet, a communicable disease surveillance system in Sweden. Participants were matched by demographics and residential county to a control of another 4,076,342 adults who did not have a positive test result. The main analysis adjusted for comorbidities, surgery, cancer, long-term anticoagulation treatment, and various other factors.

For severity among the case patients, 94.5% had mild infections, 4.8% required hospital admission, 0.7% required intensive care, and 1.8% died.

For pulmonary embolism, the absolute risk was 0.17% in the first 30 days among COVID-19 patients versus 0.004% among control patients during the same time frame. Absolute risks were 0.039% and 0.007%, respectively, for deep vein thrombosis, and 0.10% and 0.04% for bleeding.

Overall, 51% of the study participants were women, with a mean age of 40. Previous venous thromboembolism had occurred in 1.9% of the case patients and previous bleeding had occurred in 5.8%.

Study limitations included the use of registry data that may contain incomplete or inaccurate information and the fact that deep vein thrombosis could have been underdiagnosed because critically ill patients were not stable for evaluations.

  • Zaina Hamza is a staff writer for MedPage Today, covering Gastroenterology and Infectious disease. She is based in Chicago.

Disclosures

The study was supported by various foundations in Sweden and Umeå University.

Connolly and co-authors, as well as Ho and Pell, disclosed no relationships with industry.

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