Risk of recurrence after discontinuing anticoagulation in patients with COVID-19- associated venous thromboembolism: a prospective multicentre cohort studyResearch in context

• Published in: EClinicalMedicine Vol. 73; p. 102659
• Main Authors: Luis Jara-Palomares, Behnood Bikdeli, David Jiménez, Alfonso Muriel, Pablo Demelo-Rodríguez, Farès Moustafa, Aurora Villalobos, Patricia López-Miguel, Luciano López-Jiménez, Sonia Otálora, María Luisa Peris, Cristina Amado, Romain Chopard, Francisco Rivera-Cívico, Manuel Monreal, María Dolores Adarraga, Ana Alberich Conesa, Jesús Aibar, Alicia Alda Lozano, Joaquín Alfonso, Jesús Alonso Carrillo, María Angelina García, Juan Ignacio Arcelus, Aitor Ballaz, Raquel Barba, María Barca Hernando, Cristina Barbagelata, Manuel Barrón, Belén Barrón Andrés, Fahd Beddar Chaib, María Ángeles Blanco Molina, Juan Carlos Caballero, Gonzalo Castellanos, Leyre Chasco, Juan Criado, Cristina de Ancos, Jorge del Toro, Pablo Demelo Rodríguez, Cristina de Juana Izquierdo, Ana María Díaz Brasero, José Antonio Díaz Peromingo, Álvaro Dubois Silva, Juan Carlos Escribano, Concepción Falgá, Ana Isabel Farfán Sedano, Cleofe Fernández Aracil, Carmen Fernández Capitán, Begoña Fernández Jiménez, José Luis Fernández Reyes, María Ángeles Fidalgo, Iria Francisco, Cristina Gabara, Francisco Galeano Valle, Francisco García Bragado, Alberto García Ortega, Olga Gavín Sebastián, María Allende Gil de Gómez, Aída Gil Díaz, Covadonga Gómez Cuervo, Adriana González Munera, Enric Grau, Leticia Guirado, Javier Gutiérrez, Luis Hernández Blasco, Luis Jara Palomares, María Jesús Jaras, Rafael Jiménez, Inés Jou, María Dolores Joya, Sara Lainez Justo, Antonio Lalueza, Ramón Lecumberri, José Manuel León Ramírez, Pilar Llamas, José Luis Lobo, Luciano López Jiménez, Patricia López Miguel, Juan José López Núñez, Antonio López Ruiz, Juan Bosco López Sáez, Alicia Lorenzo, Marina Lumbierres, Olga Madridano, Ana Maestre, Pablo Javier Marchena, María Marcos, Mar Martín del Pozo, Francisco Martín Martos, Jorge Manuel Maza, Elisabeth Mena, Maria Isabel Mercado, Jorge Moisés, María del Valle Morales, Maria Sierra Navas, José Antonio Nieto, Manuel Jesús Núñez Fernández, Mónica Olid
• Format: Journal Article
• Language: English
• Published: Elsevier 01-07-2024
• Subjects: Anticoagulation; COVID-19; Pulmonary embolism; SARS-CoV-2; Venous thromboembolism
• ISSN: 2589-5370

Background: The clinical relevance of recurrent venous thromboembolism (VTE) after discontinuing anticoagulation in patients with COVID-19-associated VTE remains uncertain. We estimated the incidence rates and mortality of VTE recurrences developing after discontinuing anticoagulation in patients with COVID-19-associated VTE. Methods: A prospective, multicenter, non-interventional study was conducted between March 25, 2020, and July 26, 2023, including patients who had discontinued anticoagulation after at least 3 months of therapy. All patients from the registry were analyzed during the study period to verify inclusion criteria. Patients with superficial vein thrombosis, those who did not receive at least 3 months of anticoagulant therapy, and those who were followed for less than 15 days after discontinuing anticoagulation were excluded. Outcomes were: 1) Incidence rates of symptomatic VTE recurrences, and 2) fatal PE. The rate of VTE recurrences was defined as the number of patients with recurrent VTE divided by the patient-years at risk of recurrent VTE during the period when anticoagulation was discontinued. Findings: Among 1106 patients with COVID-19-associated VTE (age 62.3 ± 14.4 years; 62.9% male) followed-up for 12.5 months (p25-75, 6.3–20.1) after discontinuing anticoagulation, there were 38 VTE recurrences (3.5%, 95% confidence interval [CI]: 2.5–4.7%), with a rate of 3.1 per 100 patient-years (95% CI: 2.2–4.2). No patient died of recurrent PE (0%, 95% CI: 0–7.6%). Subgroup analyses showed that patients with diagnosis in 2021–2022 (vs. 2020) (Hazard ratio [HR] 2.86; 95% CI 1.45–5.68) or those with isolated deep vein thrombosis (vs. pulmonary embolism) (HR 2.31; 95% CI 1.19–4.49) had significantly higher rates of VTE recurrences. Interpretation: In patients with COVID-19-associated VTE who discontinued anticoagulation after at least 3 months of treatment, the incidence rate of recurrent VTE and the case-fatality rate was low. Therefore, it conceivable that long-term anticoagulation may not be required for many patients with COVID-19-associated VTE, although further research is needed to confirm these findings. Funding: Sanofi and Rovi, Sanofi Spain.