Siegal Deborah M, Arsenault Marie Pier, Abdulrehman Jameel, Cervi Andrea, Cheung Andrew, Cuker Adam, Delluc Aurelien, Koolian Maral, Le Gal Grégoire, Mallick Ranjeeta, Moschella Alexa, Ostrowski Margaret, Rockwell Chantal, Schneider Prism, Tritschler Tobias, West Carol, Wang Tzu Fei, Zarychanski Ryan, Carrier Marc
Department of Medicine, University of Ottawa, Ottawa, Canada; Inflammation and Chronic Diseases Program, Ottawa Hospital Research Institute, Ottawa, Canada.
Department of Medicine, Hospital Maisonneuve-Rosemont, Université de Montréal, Montreal, Canada.
J Thromb Haemost. 2025 Aug;23(8):2550-2557. doi: 10.1016/j.jtha.2025.04.018. Epub 2025 Apr 25.
COVID-19 induces a prothrombotic state that increases the risk of venous thromboembolism (VTE) in hospitalized patients, but the incidence of postdischarge VTE is not well characterized in prospective studies.
To determine the incidence of symptomatic VTE after hospitalization with COVID-19 infection.
The Venous Thrombosis Virtual Surveillance in COVID (VVIRTUOSO) study was a prospective multicenter cohort study (2021 to 2022) conducted at 6 sites in Canada. Patients ≥18 years, hospitalized for laboratory-confirmed COVID-19 or diagnosed during hospitalization within 1 week of hospital discharge, were included and followed virtually for 90 days (telephone or video). Exclusion criteria included unconfirmed diagnosis of COVID-19, no access to a telephone, computer, or tablet for virtual assessment, therapeutic-dose anticoagulation after hospital discharge, or patients (or their delegate) unable or unwilling to provide informed consent. The primary outcome was symptomatic, objectively confirmed acute VTE at 90 days. Secondary outcomes included 30-day incidence of symptomatic VTE, major bleeding, clinically relevant non-major bleeding, and mortality.
A total of 513 participants were enrolled, and 411 participants completed 90-day follow-up. Mean age was 58 years and 46% were females. At 90 days, the cumulative incidence of symptomatic VTE was 0.90% (95% CI, 0.30%-2.18%). The cumulative incidence of major bleeding was 0.20% (95% CI, 0.02-1.10), clinically relevant non-major bleeding was 1.47% (95% CI, 0.66-2.90), and mortality was 3.19% (95% CI, 1.86-5.08).
The incidence of symptomatic VTE after hospitalization with COVID-19 infection is low. Our findings suggest that routine postdischarge pharmacological thromboprophylaxis may not offer net clinical benefit for unselected patients.
新型冠状病毒肺炎（COVID-19）会引发促血栓形成状态，增加住院患者发生静脉血栓栓塞症（VTE）的风险，但前瞻性研究中对出院后VTE的发病率描述不足。
确定COVID-19感染住院后有症状VTE的发病率。
COVID静脉血栓形成虚拟监测（VVIRTUOSO）研究是一项于2021年至2022年在加拿大6个地点进行的前瞻性多中心队列研究。纳入年龄≥18岁、因实验室确诊的COVID-19住院或在出院后1周内住院期间确诊的患者，并进行为期90天的虚拟随访（电话或视频）。排除标准包括COVID-19诊断未确诊、无法使用电话、电脑或平板电脑进行虚拟评估、出院后接受治疗剂量抗凝治疗，或患者（或其代理人）无法或不愿提供知情同意书。主要结局是90天时出现症状且经客观证实的急性VTE。次要结局包括30天时症状性VTE的发生率、大出血、临床相关非大出血和死亡率。
共纳入513名参与者，411名参与者完成了90天随访。平均年龄为58岁，46%为女性。90天时，症状性VTE的累积发病率为0.90%（95%CI，0.30%-2.18%）。大出血的累积发病率为0.20%（95%CI，0.02-1.10），临床相关非大出血为1.47%（95%CI，0.66-2.90），死亡率为3.19%（95%CI，1.86-5.08）。
COVID-19感染住院后症状性VTE的发病率较低。我们的研究结果表明，对于未经过筛选的患者，出院后常规进行药物性血栓预防可能无法带来净临床获益。
