Venous Thromboembolism Management throughout the COVID-19 Era: Addressing Acute and Long-Term Challenges.

Publication date: Mar 21, 2024

Background: COVID-19 increases the risk of venous thromboembolism (VTE) through a complex interplay of mechanisms collectively referred to as immunothrombosis. Limited data exist on VTE challenges in the acute setting throughout a dynamic long-term follow-up of COVID-19 patients compared to non-COVID-19 patients. The aim of the study was to investigate acute and long-term management and complications in VTE patients with and without COVID-19. Methods: A prospective, observational, single-center cohort study on VTE patients followed from the acute care stage until 24 months post-diagnosis. Results: 157 patients, 30 with COVID-19-associated VTE and 127 unrelated to COVID-19, were enrolled. The mean follow-up was 10. 8 (+/-8. 9) months. COVID-19 patients had fewer comorbidities (1. 3 +/- 1. 29 vs. 2. 26 +/- 1. 68, p < 0. 001), a higher proportion of pulmonary embolism at baseline (96. 7% vs. 76. 4%, p = 0. 01), and had a lower probability of remaining on anticoagulant therapy after three months (p < 0. 003). The most used initial therapy was low-molecular-weight heparin in 130/157 cases, followed by long-term treatment with direct oral anticoagulants in 123/157. Two (6. 7%) COVID-19 vs. three (2. 4%) non-COVID-19 patients (p = 0. 243) had major hemorrhagic events, all of them within the first three months. Four (3. 1%) non-COVID-19 patients had VTE recurrence after six months. Three (2. 4%) non-COVID-19 patients developed chronic thromboembolic pulmonary hypertension. There were no fatalities among patients with COVID-19, compared to a mortality of 12/127 (9. 4%) in the non-COVID-19 subgroup (p = 0. 027). Discussion: Our study offers a comprehensive overview of the evolving nature of VTE management, emphasizing the importance of personalized risk-based approaches, including a limited course of anticoagulation for most COVID-19-associated VTE cases and reduced-dose extended therapy for high-risk subsets.

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Concepts Keywords
Immunothrombosis COVID-19
Months deep vein thrombosis
Pulmonary management
Stage outcomes
Unrelated pulmonary embolism
venous thromboembolism

Original Article

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