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Venous thromboembolism and major bleeding in patients with COVID-19: A nationwide population-based cohort study

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  • Michael Dalager-Pedersen
  • Lars Christian Lund
  • Theis Mariager
  • Rannva Winther
  • Maja Hellfritzsch
  • Torben Bjerregaard Larsen
  • Reimar Wernich Thomsen
  • Nanna Borup Johansen
  • Ole Schmeltz Søgaard
  • Stig Lønberg Nielsen
  • Lars Omland
  • Lene Fogt Lundbo
  • Simone Bastrup Israelsen
  • Zitta Barrella Harboe
  • Anton Pottegård
  • Henrik Nielsen
  • Jacob Bodilsen
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BACKGROUND: Venous thromboembolism (VTE) is a potentially fatal complication of SARS-CoV-2 infection and thromboprophylaxis should be balanced against risk of bleeding. This study aimed to examine risks of VTE and major bleeding in hospitalized and community-managed SARS-CoV-2 patients compared with control populations.

METHODS: Using nationwide population-based registries, 30-day risks of VTE and major bleeding in SARS-CoV-2 positive patients were compared with those of SARS-CoV-2 test-negative patients and with an external cohort of influenza patients. Medical records of all COVID-19 patients at six departments of infectious diseases in Denmark were reviewed in detail.

RESULTS: The overall 30-day risk of VTE was 0.4% (40/9,460) among SARS-CoV-2 patients (16% hospitalized), 0.3% (649/226,510) among SARS-CoV-2 negative subjects (12% hospitalized), and 1.0% (158/16,281) among influenza patients (59% hospitalized). VTE risks were higher and comparable in hospitalized SARS-CoV-2 positive (1.5%), SARS-CoV-2 negative (1.8%), and influenza patients (1.5%). Diagnosis of major bleeding was registered in 0.5% (47/9,460) of all SARS-CoV-2 positive individuals and in 2.3% of those hospitalized. Medical record review of 582 hospitalized SARS-CoV-2 patients observed VTE in 4% (19/450) and major bleeding in 0.4% (2/450) of ward patients, of whom 31% received thromboprophylaxis. Among intensive care patients (100% received thromboprophylaxis), risks were 7% (9/132) for VTE and 11% (15/132) for major bleeding.

CONCLUSIONS: Among people with SARS-CoV-2 infection in a population-based setting, VTE risks were low to moderate and were not substantially increased compared with SARS-CoV-2 test-negative and influenza patients. Risk of severe bleeding was low for ward patients, but mirrored VTE risk in the intensive care setting.

Original languageEnglish
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN1058-4838
DOIs
Publication statusPublished - 5 Jan 2021

ID: 61650577