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Pulmonary embolism and deep venous thrombosis after COVID-19 : long-term risk in a population-based cohort study

Sjöland, Helen ; Lindgren, Martin ; Toska, Triantafyllia ; Hansson, Per Olof ; Glise Sandblad, Katarina ; Alex, Christian ; Björck, Lena ; Cronie, Ottmar LU ; Björk, Jonas LU and Lundberg, Christina E. , et al. (2023) In Research and practice in thrombosis and haemostasis 7(5).
Abstract

Background: Venous thromboembolism (VTE) (pulmonary embolism [PE] or deep venous thrombosis [DVT]) is common during acute COVID-19. Long-term excess risk has not yet been established. Objectives: To study long-term VTE risk after COVID-19. Methods: Swedish citizens aged 18 to 84 years hospitalized and/or testing positive for COVID-19 between January 1, 2020, and September 11, 2021 (exposed), stratified by initial hospitalization, were compared to matched (1:5), nonexposed, population-derived subjects without COVID-19. Outcomes were incident VTE, PE, or DVT recorded within 60, 60 to <180, and ≥180 days. Cox regression was used for evaluation, and a model adjusted for age, sex, comorbidities, and socioeconomic markers was developed to... (More)

Background: Venous thromboembolism (VTE) (pulmonary embolism [PE] or deep venous thrombosis [DVT]) is common during acute COVID-19. Long-term excess risk has not yet been established. Objectives: To study long-term VTE risk after COVID-19. Methods: Swedish citizens aged 18 to 84 years hospitalized and/or testing positive for COVID-19 between January 1, 2020, and September 11, 2021 (exposed), stratified by initial hospitalization, were compared to matched (1:5), nonexposed, population-derived subjects without COVID-19. Outcomes were incident VTE, PE, or DVT recorded within 60, 60 to <180, and ≥180 days. Cox regression was used for evaluation, and a model adjusted for age, sex, comorbidities, and socioeconomic markers was developed to control for confounders. Results: Among exposed patients, 48,861 were hospitalized for COVID-19 (mean age, 60.6 years) and 894,121 were without hospitalization (mean age, 41.4 years). Among patients hospitalized for COVID-19, fully adjusted hazard ratios during 60 to <180 days were 6.05 (95% CI, 4.80-7.62) for PE and 3.97 (CI, 2.96-5.33) for DVT compared with that for nonexposed patients with corresponding estimates among those with COVID-19 without hospitalization 1.17 (CI, 1.01-1.35) and 0.99 (CI, 0.86-1.15), based on 475 and 2311 VTE events, respectively. Long-term (≥180 days) hazard ratios in patients hospitalized for COVID-19 were 2.01 (CI, 1.51-2.68) for PE and 1.46 (CI, 1.05-2.01) for DVT, while nonhospitalized patients had similar risk as nonexposed patients, based on 467 and 2030 VTE events, respectively. Conclusion: Patients hospitalized for COVID-19 retained an elevated excess risk of VTE, mainly PE, after 180 days, while long-term risk of VTE in individuals with COVID-19 without hospitalization was similar to that in the nonexposed patients.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
COVID-19/complications, COVID-19/epidemiology, pulmonary embolism, venous thromboembolism, venous thrombosis
in
Research and practice in thrombosis and haemostasis
volume
7
issue
5
article number
100284
publisher
Wiley
external identifiers
  • pmid:37361398
  • scopus:85165050954
ISSN
2475-0379
DOI
10.1016/j.rpth.2023.100284
project
Improved preparedness for future pandemics and other health crises through large-scale disease surveillance
AIR Lund - Artificially Intelligent use of Registers
language
English
LU publication?
yes
id
7485828f-0b37-479c-9607-ab91709546a6
date added to LUP
2023-09-13 08:34:00
date last changed
2024-04-20 03:08:27
@article{7485828f-0b37-479c-9607-ab91709546a6,
  abstract     = {{<p>Background: Venous thromboembolism (VTE) (pulmonary embolism [PE] or deep venous thrombosis [DVT]) is common during acute COVID-19. Long-term excess risk has not yet been established. Objectives: To study long-term VTE risk after COVID-19. Methods: Swedish citizens aged 18 to 84 years hospitalized and/or testing positive for COVID-19 between January 1, 2020, and September 11, 2021 (exposed), stratified by initial hospitalization, were compared to matched (1:5), nonexposed, population-derived subjects without COVID-19. Outcomes were incident VTE, PE, or DVT recorded within 60, 60 to &lt;180, and ≥180 days. Cox regression was used for evaluation, and a model adjusted for age, sex, comorbidities, and socioeconomic markers was developed to control for confounders. Results: Among exposed patients, 48,861 were hospitalized for COVID-19 (mean age, 60.6 years) and 894,121 were without hospitalization (mean age, 41.4 years). Among patients hospitalized for COVID-19, fully adjusted hazard ratios during 60 to &lt;180 days were 6.05 (95% CI, 4.80-7.62) for PE and 3.97 (CI, 2.96-5.33) for DVT compared with that for nonexposed patients with corresponding estimates among those with COVID-19 without hospitalization 1.17 (CI, 1.01-1.35) and 0.99 (CI, 0.86-1.15), based on 475 and 2311 VTE events, respectively. Long-term (≥180 days) hazard ratios in patients hospitalized for COVID-19 were 2.01 (CI, 1.51-2.68) for PE and 1.46 (CI, 1.05-2.01) for DVT, while nonhospitalized patients had similar risk as nonexposed patients, based on 467 and 2030 VTE events, respectively. Conclusion: Patients hospitalized for COVID-19 retained an elevated excess risk of VTE, mainly PE, after 180 days, while long-term risk of VTE in individuals with COVID-19 without hospitalization was similar to that in the nonexposed patients.</p>}},
  author       = {{Sjöland, Helen and Lindgren, Martin and Toska, Triantafyllia and Hansson, Per Olof and Glise Sandblad, Katarina and Alex, Christian and Björck, Lena and Cronie, Ottmar and Björk, Jonas and Lundberg, Christina E. and Adiels, Martin and Rosengren, Annika}},
  issn         = {{2475-0379}},
  keywords     = {{COVID-19/complications; COVID-19/epidemiology; pulmonary embolism; venous thromboembolism; venous thrombosis}},
  language     = {{eng}},
  number       = {{5}},
  publisher    = {{Wiley}},
  series       = {{Research and practice in thrombosis and haemostasis}},
  title        = {{Pulmonary embolism and deep venous thrombosis after COVID-19 : long-term risk in a population-based cohort study}},
  url          = {{http://dx.doi.org/10.1016/j.rpth.2023.100284}},
  doi          = {{10.1016/j.rpth.2023.100284}},
  volume       = {{7}},
  year         = {{2023}},
}