Venous Thromboembolism and Major Bleeding in Patients With Coronavirus Disease 2019 (COVID-19): A Nationwide, Population-Based Cohort Study
Abstract Background Venous thromboembolism (VTE) is a potentially fatal complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and thromboprophylaxis should be balanced against risk of bleeding. This study examined risks of VTE and major bleeding in hospitalized and...
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| Veröffentlicht in: | Clinical infectious diseases 2021-12, Vol.73 (12), p.2283-2293 |
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| creator | Dalager-Pedersen, Michael Lund, Lars Christian Mariager, Theis Winther, Rannva Hellfritzsch, Maja Larsen, Torben Bjerregaard Thomsen, Reimar Wernich Johansen, Nanna Borup Søgaard, Ole Schmeltz Nielsen, Stig Lønberg Omland, Lars Haukali Lundbo, Lene Fogt Israelsen, Simone Bastrup Harboe, Zitta Barrella Pottegård, Anton Nielsen, Henrik Bodilsen, Jacob |
| description | Abstract
Background
Venous thromboembolism (VTE) is a potentially fatal complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and thromboprophylaxis should be balanced against risk of bleeding. This study examined 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 6 departments of infectious diseases in Denmark were reviewed in detail.
Results
The overall 30-day risk of VTE was 0.4% (40/9460) 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% (47/9460) 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.
Risks of venous thrombolism and major bleeding were low to moderate in hospitalized and community-managed COVID-19 patients. These risks were comparable with patients suspected of but testing negative for SARS-CoV-2 and with influenza patients. |
| doi_str_mv | 10.1093/cid/ciab003 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2475531795</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/cid/ciab003</oup_id><sourcerecordid>2475531795</sourcerecordid><originalsourceid>FETCH-LOGICAL-c357t-143fdf9124d696ac4953bd1bcf27d3349c26fb0bfd4b481011e5d577b79afd083</originalsourceid><addsrcrecordid>eNp9kMtOwzAQRS0E4lFYsUdeoSII2HFcx-xKeFXiUYlSlpEdO9QoiYudgPgGfhpDC0sWo5mRzhxpLgC7GB1jxMlJYVQoIREiK2ATU8KiAeV4NcyIplGSknQDbHn_ghDGKaLrYIOQBCHG8Cb4nOrGdh5OZs7W0upQlfE1FI2Ct-LFOnhWaa1M8wxNA8eiNbppPXwy7Qxm1tlGvBkX7s-N18JrGCPMYT-7n47OI8wPTuEQ3oUj27wbpY_g2M676mePzgKugmNmXQsf2k59bIO1UlRe7yx7DzxeXkyy6-jm_mqUDW-iglDWRjghpSo5jhM14ANRJJwSqbAsypip8Bkv4kEpkSxVIpMUh6c1VZQxybgoFUpJD_QX3rmzr532bV4bX-iqEo0OWeRxwiglmAVvDxwu0MJZ750u87kztXAfOUb5d_p5SD9fph_ovaW4k7VWf-xv3AHYXwC2m_9r-gItZo1s</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2475531795</pqid></control><display><type>article</type><title>Venous Thromboembolism and Major Bleeding in Patients With Coronavirus Disease 2019 (COVID-19): A Nationwide, Population-Based Cohort Study</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>Alma/SFX Local Collection</source><creator>Dalager-Pedersen, Michael ; Lund, Lars Christian ; Mariager, Theis ; Winther, Rannva ; Hellfritzsch, Maja ; Larsen, Torben Bjerregaard ; Thomsen, Reimar Wernich ; Johansen, Nanna Borup ; Søgaard, Ole Schmeltz ; Nielsen, Stig Lønberg ; Omland, Lars Haukali ; Lundbo, Lene Fogt ; Israelsen, Simone Bastrup ; Harboe, Zitta Barrella ; Pottegård, Anton ; Nielsen, Henrik ; Bodilsen, Jacob</creator><creatorcontrib>Dalager-Pedersen, Michael ; Lund, Lars Christian ; Mariager, Theis ; Winther, Rannva ; Hellfritzsch, Maja ; Larsen, Torben Bjerregaard ; Thomsen, Reimar Wernich ; Johansen, Nanna Borup ; Søgaard, Ole Schmeltz ; Nielsen, Stig Lønberg ; Omland, Lars Haukali ; Lundbo, Lene Fogt ; Israelsen, Simone Bastrup ; Harboe, Zitta Barrella ; Pottegård, Anton ; Nielsen, Henrik ; Bodilsen, Jacob</creatorcontrib><description>Abstract
Background
Venous thromboembolism (VTE) is a potentially fatal complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and thromboprophylaxis should be balanced against risk of bleeding. This study examined 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 6 departments of infectious diseases in Denmark were reviewed in detail.
Results
The overall 30-day risk of VTE was 0.4% (40/9460) 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% (47/9460) 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.
Risks of venous thrombolism and major bleeding were low to moderate in hospitalized and community-managed COVID-19 patients. These risks were comparable with patients suspected of but testing negative for SARS-CoV-2 and with influenza patients.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciab003</identifier><identifier>PMID: 33400771</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Anticoagulants ; Cohort Studies ; COVID-19 ; Hemorrhage - epidemiology ; Humans ; SARS-CoV-2 ; Venous Thromboembolism - epidemiology</subject><ispartof>Clinical infectious diseases, 2021-12, Vol.73 (12), p.2283-2293</ispartof><rights>The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. 2021</rights><rights>The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c357t-143fdf9124d696ac4953bd1bcf27d3349c26fb0bfd4b481011e5d577b79afd083</citedby><cites>FETCH-LOGICAL-c357t-143fdf9124d696ac4953bd1bcf27d3349c26fb0bfd4b481011e5d577b79afd083</cites><orcidid>0000-0002-7398-814X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33400771$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dalager-Pedersen, Michael</creatorcontrib><creatorcontrib>Lund, Lars Christian</creatorcontrib><creatorcontrib>Mariager, Theis</creatorcontrib><creatorcontrib>Winther, Rannva</creatorcontrib><creatorcontrib>Hellfritzsch, Maja</creatorcontrib><creatorcontrib>Larsen, Torben Bjerregaard</creatorcontrib><creatorcontrib>Thomsen, Reimar Wernich</creatorcontrib><creatorcontrib>Johansen, Nanna Borup</creatorcontrib><creatorcontrib>Søgaard, Ole Schmeltz</creatorcontrib><creatorcontrib>Nielsen, Stig Lønberg</creatorcontrib><creatorcontrib>Omland, Lars Haukali</creatorcontrib><creatorcontrib>Lundbo, Lene Fogt</creatorcontrib><creatorcontrib>Israelsen, Simone Bastrup</creatorcontrib><creatorcontrib>Harboe, Zitta Barrella</creatorcontrib><creatorcontrib>Pottegård, Anton</creatorcontrib><creatorcontrib>Nielsen, Henrik</creatorcontrib><creatorcontrib>Bodilsen, Jacob</creatorcontrib><title>Venous Thromboembolism and Major Bleeding in Patients With Coronavirus Disease 2019 (COVID-19): A Nationwide, Population-Based Cohort Study</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Abstract
Background
Venous thromboembolism (VTE) is a potentially fatal complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and thromboprophylaxis should be balanced against risk of bleeding. This study examined 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 6 departments of infectious diseases in Denmark were reviewed in detail.
Results
The overall 30-day risk of VTE was 0.4% (40/9460) 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% (47/9460) 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.
Risks of venous thrombolism and major bleeding were low to moderate in hospitalized and community-managed COVID-19 patients. These risks were comparable with patients suspected of but testing negative for SARS-CoV-2 and with influenza patients.</description><subject>Anticoagulants</subject><subject>Cohort Studies</subject><subject>COVID-19</subject><subject>Hemorrhage - epidemiology</subject><subject>Humans</subject><subject>SARS-CoV-2</subject><subject>Venous Thromboembolism - epidemiology</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtOwzAQRS0E4lFYsUdeoSII2HFcx-xKeFXiUYlSlpEdO9QoiYudgPgGfhpDC0sWo5mRzhxpLgC7GB1jxMlJYVQoIREiK2ATU8KiAeV4NcyIplGSknQDbHn_ghDGKaLrYIOQBCHG8Cb4nOrGdh5OZs7W0upQlfE1FI2Ct-LFOnhWaa1M8wxNA8eiNbppPXwy7Qxm1tlGvBkX7s-N18JrGCPMYT-7n47OI8wPTuEQ3oUj27wbpY_g2M676mePzgKugmNmXQsf2k59bIO1UlRe7yx7DzxeXkyy6-jm_mqUDW-iglDWRjghpSo5jhM14ANRJJwSqbAsypip8Bkv4kEpkSxVIpMUh6c1VZQxybgoFUpJD_QX3rmzr532bV4bX-iqEo0OWeRxwiglmAVvDxwu0MJZ750u87kztXAfOUb5d_p5SD9fph_ovaW4k7VWf-xv3AHYXwC2m_9r-gItZo1s</recordid><startdate>20211216</startdate><enddate>20211216</enddate><creator>Dalager-Pedersen, Michael</creator><creator>Lund, Lars Christian</creator><creator>Mariager, Theis</creator><creator>Winther, Rannva</creator><creator>Hellfritzsch, Maja</creator><creator>Larsen, Torben Bjerregaard</creator><creator>Thomsen, Reimar Wernich</creator><creator>Johansen, Nanna Borup</creator><creator>Søgaard, Ole Schmeltz</creator><creator>Nielsen, Stig Lønberg</creator><creator>Omland, Lars Haukali</creator><creator>Lundbo, Lene Fogt</creator><creator>Israelsen, Simone Bastrup</creator><creator>Harboe, Zitta Barrella</creator><creator>Pottegård, Anton</creator><creator>Nielsen, Henrik</creator><creator>Bodilsen, Jacob</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7398-814X</orcidid></search><sort><creationdate>20211216</creationdate><title>Venous Thromboembolism and Major Bleeding in Patients With Coronavirus Disease 2019 (COVID-19): A Nationwide, Population-Based Cohort Study</title><author>Dalager-Pedersen, Michael ; Lund, Lars Christian ; Mariager, Theis ; Winther, Rannva ; Hellfritzsch, Maja ; Larsen, Torben Bjerregaard ; Thomsen, Reimar Wernich ; Johansen, Nanna Borup ; Søgaard, Ole Schmeltz ; Nielsen, Stig Lønberg ; Omland, Lars Haukali ; Lundbo, Lene Fogt ; Israelsen, Simone Bastrup ; Harboe, Zitta Barrella ; Pottegård, Anton ; Nielsen, Henrik ; Bodilsen, Jacob</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c357t-143fdf9124d696ac4953bd1bcf27d3349c26fb0bfd4b481011e5d577b79afd083</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Anticoagulants</topic><topic>Cohort Studies</topic><topic>COVID-19</topic><topic>Hemorrhage - epidemiology</topic><topic>Humans</topic><topic>SARS-CoV-2</topic><topic>Venous Thromboembolism - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dalager-Pedersen, Michael</creatorcontrib><creatorcontrib>Lund, Lars Christian</creatorcontrib><creatorcontrib>Mariager, Theis</creatorcontrib><creatorcontrib>Winther, Rannva</creatorcontrib><creatorcontrib>Hellfritzsch, Maja</creatorcontrib><creatorcontrib>Larsen, Torben Bjerregaard</creatorcontrib><creatorcontrib>Thomsen, Reimar Wernich</creatorcontrib><creatorcontrib>Johansen, Nanna Borup</creatorcontrib><creatorcontrib>Søgaard, Ole Schmeltz</creatorcontrib><creatorcontrib>Nielsen, Stig Lønberg</creatorcontrib><creatorcontrib>Omland, Lars Haukali</creatorcontrib><creatorcontrib>Lundbo, Lene Fogt</creatorcontrib><creatorcontrib>Israelsen, Simone Bastrup</creatorcontrib><creatorcontrib>Harboe, Zitta Barrella</creatorcontrib><creatorcontrib>Pottegård, Anton</creatorcontrib><creatorcontrib>Nielsen, Henrik</creatorcontrib><creatorcontrib>Bodilsen, Jacob</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dalager-Pedersen, Michael</au><au>Lund, Lars Christian</au><au>Mariager, Theis</au><au>Winther, Rannva</au><au>Hellfritzsch, Maja</au><au>Larsen, Torben Bjerregaard</au><au>Thomsen, Reimar Wernich</au><au>Johansen, Nanna Borup</au><au>Søgaard, Ole Schmeltz</au><au>Nielsen, Stig Lønberg</au><au>Omland, Lars Haukali</au><au>Lundbo, Lene Fogt</au><au>Israelsen, Simone Bastrup</au><au>Harboe, Zitta Barrella</au><au>Pottegård, Anton</au><au>Nielsen, Henrik</au><au>Bodilsen, Jacob</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Venous Thromboembolism and Major Bleeding in Patients With Coronavirus Disease 2019 (COVID-19): A Nationwide, Population-Based Cohort Study</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2021-12-16</date><risdate>2021</risdate><volume>73</volume><issue>12</issue><spage>2283</spage><epage>2293</epage><pages>2283-2293</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>Abstract
Background
Venous thromboembolism (VTE) is a potentially fatal complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and thromboprophylaxis should be balanced against risk of bleeding. This study examined 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 6 departments of infectious diseases in Denmark were reviewed in detail.
Results
The overall 30-day risk of VTE was 0.4% (40/9460) 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% (47/9460) 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.
Risks of venous thrombolism and major bleeding were low to moderate in hospitalized and community-managed COVID-19 patients. These risks were comparable with patients suspected of but testing negative for SARS-CoV-2 and with influenza patients.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>33400771</pmid><doi>10.1093/cid/ciab003</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-7398-814X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | Clinical infectious diseases, 2021-12, Vol.73 (12), p.2283-2293 |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Anticoagulants Cohort Studies COVID-19 Hemorrhage - epidemiology Humans SARS-CoV-2 Venous Thromboembolism - epidemiology |
| title | Venous Thromboembolism and Major Bleeding in Patients With Coronavirus Disease 2019 (COVID-19): A Nationwide, Population-Based Cohort Study |
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