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SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study

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@article{2714c55d83984dbb97fb201253e64de5,
title = "SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study",
abstract = "SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3-6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.",
keywords = "COVID-19, deep vein thrombosis, pulmonary embolism, SARS-CoV-2, venous thromboembolism",
author = "{COVIDSurg Collaborative} and Meyhoff, {Christian Sylvest} and Bonde Peter and Ebbeh{\o}j, {Anders Lyng} and Anne-Sofie Fenger and Haugstvedt, {Aleksander Fjeld} and Hansen, {Christine Hangaard} and J{\"o}nsson, {Maria Lovisa} and J{\o}rgensen, {Lars Nannestad} and Peter-Martin Krarup and Anne-Louise Lihn and Otte, {Helena Roed} and Henrik Palm and Schlesinger, {Nis Hallundb{\ae}k} and Smith, {Henry George} and Amar, {Anas Ould Si} and Ida Tryggedsson",
note = "{\textcopyright} 2021 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.",
year = "2021",
month = sep,
doi = "10.1111/anae.15563",
language = "English",
volume = "215",
journal = "Anaesthesia",
issn = "0003-2409",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "6",

}

RIS

TY - JOUR

T1 - SARS-CoV-2 infection and venous thromboembolism after surgery

T2 - an international prospective cohort study

AU - COVIDSurg Collaborative

A2 - Meyhoff, Christian Sylvest

A2 - Peter, Bonde

A2 - Ebbehøj, Anders Lyng

A2 - Fenger, Anne-Sofie

A2 - Haugstvedt, Aleksander Fjeld

A2 - Hansen, Christine Hangaard

A2 - Jönsson, Maria Lovisa

A2 - Jørgensen, Lars Nannestad

A2 - Krarup, Peter-Martin

A2 - Lihn, Anne-Louise

A2 - Otte, Helena Roed

A2 - Palm, Henrik

A2 - Schlesinger, Nis Hallundbæk

A2 - Smith, Henry George

A2 - Amar, Anas Ould Si

A2 - Tryggedsson, Ida

N1 - © 2021 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.

PY - 2021/9

Y1 - 2021/9

N2 - SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3-6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

AB - SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3-6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

KW - COVID-19

KW - deep vein thrombosis

KW - pulmonary embolism

KW - SARS-CoV-2

KW - venous thromboembolism

UR - http://www.scopus.com/inward/record.url?scp=85113318546&partnerID=8YFLogxK

U2 - 10.1111/anae.15563

DO - 10.1111/anae.15563

M3 - Journal article

C2 - 34428858

VL - 215

JO - Anaesthesia

JF - Anaesthesia

SN - 0003-2409

IS - 6

ER -

ID: 67450473