“Universal prescription of postdischarge anticoagulation in patients with COVID-19 offers marginal clinical benefits and may cause harm in patients at high risk of bleeding,” Li et al note. It’s not clear, though, that this strategy is of benefit considering the low rate of VTE events observed after patients leave the hospital. In some centers, patients have been discharged on short courses of anticoagulation after discharge. Once it became clear that COVID-19 comes with a greater risk of arterial and venous thrombosis, studies were launched to determine how antithrombotic therapies should be deployed to counteract it. I think there’s also a lot more work needed to understand what kind of anticoagulants to use, how are they dosed, and how long we would need to use them for.” Some of this may be explained by known VTE/, some of these may be undiagnosed thromboembolic complications. “Looking at this study, even if you survive to discharge, the incidence of 90-day mortality is still 4%. “We are seeing lower rates of thromboembolism compared with earlier during the pandemic, but this is still a sick population,” she told TCTMD via email.
That stance is consistent with guidance from the US National Institutes of Health (NIH), which discourages routine use of VTE prophylaxis at discharge but states that extended anticoagulation “can be considered” in patients with a low bleeding risk and high thrombosis risk according to established risk scores.īut Tracy Wang, MD (Duke Clinical Research Institute, Durham, NC), indicated that it remains unclear whether this is a valid approach.
“We propose that anticoagulation may be considered in the high-risk populations, and we have to make sure that their bleeding risk is low.” “We agree that routine anticoagulation is not recommended for every COVID patient after their hospital discharge,” study co-author Wei Zhao, MD, PhD (Ascension St. On the other hand, patients who received anticoagulation, particularly at therapeutic doses (as opposed to lower prophylactic doses), had markedly reduced odds of VTE events. Specifically, patients with a history of VTE, a D-dimer level above 3 μg/mL, or a predischarge C-reactive protein (CRP) level greater than 10 mg/dL had greater odds of VTE events within the first 90 days after leaving the hospital, lead author Pin Li, PhD (Henry Ford Health System, Detroit, MI), and colleagues report in a study published online this week in JAMA Network Open.