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Vol. 223. Issue 5.
Pages 255-261 (May 2023)
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Vol. 223. Issue 5.
Pages 255-261 (May 2023)
Original article
Risk of thrombosis recurrence among patients with COVID-19 and surgery-associated venous thromboembolism
Riesgo de recurrencia de trombosis entre pacientes con COVID-19 y tromboembolismo venoso asociado a cirugía
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R. Alonso-Beatoa,b, M.-O. Lago-Rodrígueza, M. López-Rubioa, A. Gómez-Tórtolaa, I. García-Fernández-Bravoa, C.-M. Oblitasa,b,c,
Corresponding author
christian.amodeo@iisgm.com

Corresponding author.
, F. Galeano-Vallea,b,c, P. Demelo-Rodrígueza,b,c
a Venous Thromboembolism Unit, Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b Facultad de Medicina, Universidad Complutense de Madrid, Spain
c Instituto de Investigación Sanitaria Gregorio Marañón, Spain
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Table 1. Baseline characteristics, risk factors, and clinical presentations.
Table 2. Treatment and clinical outcomes.
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Abstract
Introduction

Recent surgery is a well-known major transient risk factor for venous thromboembolism (VTE) due to the low risk of VTE recurrence after anticoagulation is discontinued. On the other hand, the risk of VTE recurrence among patients with COVID-19-associated VTE is unknown. This study aimed to compare the risk of VTE recurrence between patients with COVID-19- and surgery-associated VTE.

Methods

A prospective observational single-center study was performed including consecutive patients diagnosed with VTE in a tertiary hospital from January 2020 to May 2022 and followed up for at least 90 days. Baseline characteristics, clinical presentation, and outcomes were assessed. The incidence of VTE recurrence, bleeding, and death was compared between both groups.

Results

A total of 344 patients were included in the study: 111 patients with surgery-associated VTE and 233 patients with COVID-19-associated VTE. Patients with COVID-19-associated VTE were more frequently men (65.7% vs 48.6%, p =  0.003). VTE recurrence was 3% among COVID-19 patients and 5.4% among surgical patients, with no significant differences (p =  0.364). The incidence rate of recurrent VTE was 1.25 per 1000 person-months in COVID-19 patients and 2.29 person-months in surgical patients, without significant differences (p =  0.29). In the multivariate analysis, COVID-19 was associated with higher mortality (HR 2.34; 95% CI 1.19–4.58), but not with a higher risk of recurrence (HR 0.52; 95% CI 0.17–1.61). No differences were found in recurrence in the multivariate competing risk analysis (SHR 0.82; 95% CI 0.40–2.05).

Conclusions

In patients with COVID-19 and surgery-associated VTE, the risk of recurrence was low, with no differences between both groups.

Keywords:
COVID-19
Deep vein thrombosis
Pulmonary embolism
Risk factor
Surgery
Venous thromboembolism
Resumen
Introducción

La cirugía reciente es un importante factor de riesgo transitorio bien conocido para tromboembolismo venoso (TEV) debido al bajo riesgo de recurrencia de TEV después de suspender la anticoagulación. Por otro lado, se desconoce el riesgo de recurrencia de TEV entre pacientes con TEV asociado a COVID-19. Este estudio tuvo como objetivo comparar el riesgo de recurrencia de TEV entre pacientes con TEV asociado a cirugía y COVID-19.

Métodos

Se realizó un estudio prospectivo observacional unicéntrico que incluyó pacientes consecutivos diagnosticados de TEV en un hospital terciario desde enero de 2020 hasta mayo de 2022 y seguidos durante al menos 90 días. Se evaluaron las características iniciales, la presentación clínica y los resultados. Se comparó la incidencia de recurrencia de TEV, hemorragia y muerte entre ambos grupos.

Resultados

Se incluyeron en el estudio un total de 344 pacientes: 111 pacientes con TEV asociada a cirugía y 233 pacientes con TEV asociada a COVID-19. Los pacientes con TEV asociada a COVID-19 fueron con mayor frecuencia hombres (65,7% vs 48,6%, p = 0,003). La recurrencia de TEV fue del 3% entre los pacientes con COVID-19 y del 5,4% entre los pacientes quirúrgicos, sin diferencias significativas (p = 0,364). La tasa de incidencia de TEV recurrente fue de 1,25 por 1000 personas-mes en pacientes con COVID-19 y de 2,29 personas-mes en pacientes quirúrgicos, sin diferencias significativas (p = 0,29). En el análisis multivariado, la COVID-19 se asoció con mayor mortalidad (HR 2,34; IC 95% 1,19-4,58), pero no con mayor riesgo de recurrencia (HR 0,52; IC 95% 0,17−1,61). No se encontraron diferencias en la recurrencia en el análisis multivariado de riesgos competitivos (SHR 0,82; IC 95% 0,40 – 2,05).

Conclusiones

En pacientes con COVID-19 y TEV asociada a cirugía, el riesgo de recurrencia fue bajo, sin diferencias entre ambos grupos.

Palabras clave:
COVID-19
Trombosis venosa profunda
Embolia pulmonar
Factor de riesgo
Cirugía
Tromboembolismo venoso

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