Venous Thromboembolism and Major Bleeding in Patients With Coronavirus Disease 2019 (COVID-19): A Nationwide, Population-Based Cohort Study

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

doi:10.1093/cid/ciab003

Venous Thromboembolism and Major Bleeding in Patients With Coronavirus Disease 2019 (COVID-19): A Nationwide, Population-Based Cohort Study

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^*

^*Corresponding author for this work

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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.

Original language	English
Journal	Clinical Infectious Diseases
Volume	73
Issue number	12
Pages (from-to)	2283–2293
Number of pages	11
ISSN	1058-4838
DOIs	https://doi.org/10.1093/cid/ciab003
Publication status	Published - 15 Dec 2021

Keywords

Anticoagulants
COVID-19
Cohort Studies
Hemorrhage/epidemiology
Humans
SARS-CoV-2
Venous Thromboembolism/epidemiology

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Dalager-Pedersen, M., Lund, L. C., Mariager, T., Winther, R., Hellfritzsch, M., Larsen, T. B., Thomsen, R. W., Johansen, N. B., Søgaard, O. S., Nielsen, S. L., Omland, L., Lundbo, L. F., Israelsen, S. B., Harboe, Z. B., Pottegård, A., Nielsen, H., & Bodilsen, J. (2021). Venous Thromboembolism and Major Bleeding in Patients With Coronavirus Disease 2019 (COVID-19): A Nationwide, Population-Based Cohort Study. Clinical Infectious Diseases, 73(12), 2283–2293. Advance online publication. https://doi.org/10.1093/cid/ciab003

@article{73fe1b8ef0a241f397a0ef9eef231942,

title = "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 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.",

keywords = "Anticoagulants, COVID-19, Cohort Studies, Hemorrhage/epidemiology, Humans, SARS-CoV-2, Venous Thromboembolism/epidemiology",

author = "Michael Dalager-Pedersen and Lund, {Lars Christian} and Theis Mariager and Rannva Winther and Maja Hellfritzsch and Larsen, {Torben Bjerregaard} and Thomsen, {Reimar Wernich} and Johansen, {Nanna Borup} and S{\o}gaard, {Ole Schmeltz} and Nielsen, {Stig L{\o}nberg} and Lars Omland and Lundbo, {Lene Fogt} and Israelsen, {Simone Bastrup} and Harboe, {Zitta Barrella} and Anton Potteg{\aa}rd and Henrik Nielsen and Jacob Bodilsen",

note = "{\textcopyright} 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.",

year = "2021",

month = dec,

day = "15",

doi = "10.1093/cid/ciab003",

language = "English",

volume = "73",

pages = "2283–2293",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "12",

}

Dalager-Pedersen, M, Lund, LC, Mariager, T, Winther, R, Hellfritzsch, M, Larsen, TB, Thomsen, RW, Johansen, NB, Søgaard, OS, Nielsen, SL, Omland, L, Lundbo, LF, Israelsen, SB, Harboe, ZB, Pottegård, A, Nielsen, H & Bodilsen, J 2021, 'Venous Thromboembolism and Major Bleeding in Patients With Coronavirus Disease 2019 (COVID-19): A Nationwide, Population-Based Cohort Study', Clinical Infectious Diseases, vol. 73, no. 12, pp. 2283–2293. https://doi.org/10.1093/cid/ciab003

Venous Thromboembolism and Major Bleeding in Patients With Coronavirus Disease 2019 (COVID-19): A Nationwide, Population-Based Cohort Study. / Dalager-Pedersen, Michael; Lund, Lars Christian; Mariager, Theis et al.
In: Clinical Infectious Diseases, Vol. 73, No. 12, 15.12.2021, p. 2283–2293.

Research output: Contribution to journal › Journal article › Research › peer-review

TY - JOUR

T1 - Venous Thromboembolism and Major Bleeding in Patients With Coronavirus Disease 2019 (COVID-19)

T2 - A Nationwide, Population-Based Cohort Study

AU - Dalager-Pedersen, Michael

AU - Lund, Lars Christian

AU - Mariager, Theis

AU - Winther, Rannva

AU - Hellfritzsch, Maja

AU - Larsen, Torben Bjerregaard

AU - Thomsen, Reimar Wernich

AU - Johansen, Nanna Borup

AU - Søgaard, Ole Schmeltz

AU - Nielsen, Stig Lønberg

AU - Omland, Lars

AU - Lundbo, Lene Fogt

AU - Israelsen, Simone Bastrup

AU - Harboe, Zitta Barrella

AU - Pottegård, Anton

AU - Nielsen, Henrik

AU - Bodilsen, Jacob

PY - 2021/12/15

Y1 - 2021/12/15

N2 - 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.

AB - 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.

KW - Anticoagulants

KW - COVID-19

KW - Cohort Studies

KW - Hemorrhage/epidemiology

KW - Humans

KW - SARS-CoV-2

KW - Venous Thromboembolism/epidemiology

UR - http://www.scopus.com/inward/record.url?scp=85122841385&partnerID=8YFLogxK

U2 - 10.1093/cid/ciab003

DO - 10.1093/cid/ciab003

M3 - Journal article

C2 - 33400771

SN - 1058-4838

VL - 73

SP - 2283

EP - 2293

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 12

ER -

Venous Thromboembolism and Major Bleeding in Patients With Coronavirus Disease 2019 (COVID-19): A Nationwide, Population-Based Cohort Study

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