Venous thromboembolism in an Asian COVID-19 cohort across 3 infection waves-a retrospective observational study

Shir Ying Lee; Winnie Z Y Teo; Cheryl X Q Lim; Chun Tsu Lee; Wei-Ying Jen; Sanjay de Mel; Eng Soo Yap; Yen-Lin Chee

doi:10.1016/j.rpth.2023.102218

Venous thromboembolism in an Asian COVID-19 cohort across 3 infection waves-a retrospective observational study

Res Pract Thromb Haemost. 2023 Oct 11;7(7):102218. doi: 10.1016/j.rpth.2023.102218. eCollection 2023 Oct.

Authors

Shir Ying Lee^{1

2

3}, Winnie Z Y Teo^{2

4}, Cheryl X Q Lim^{1

2}, Chun Tsu Lee^{2

4}, Wei-Ying Jen², Sanjay de Mel^{2

3}, Eng Soo Yap^{1

2}, Yen-Lin Chee²

Affiliations

¹ Division of Haematology, Department of Laboratory Medicine, National University Hospital, Singapore.
² Department of Haematology-Oncology, National University Cancer Institute Singapore, National University Hospital, Singapore.
³ Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁴ Fast and Chronic Program, Department of Medicine, Alexandra Hospital, Singapore.

Abstract

Background: A high incidence of venous thromboembolism (VTE) in COVID-19 has led to international recommendations for thromboprophylaxis. With limited data on Asian patients with COVID-19, the role of thromboprophylaxis remains unclear.

Objectives: To investigate the in-hospital incidence of VTE in an Asian COVID-19 cohort, describe the VTE trend through successive COVID-19 waves (wild-type, delta, and omicron), and characterize the risk factors for VTE.

Methods: We performed a retrospective observational cohort study of hospitalized COVID-19 adults from January 2020 to February 2022. Objectively confirmed VTE were reviewed to obtain VTE incidence and trend. Subset analysis of critical (intensive care), moderate (oxygen supplementation), and mild cases hospitalized ≥5 days was performed to investigate risk factors and in-hospital hazards of VTE.

Results: Sixteen VTE events occurred among 3574 patients. Overall, VTE incidence was 0.45%, or 0.21% in mild, 3.60% in moderate, and 5.38% in critical infection. The maximum cumulative risk of VTE was 1.14% at 14 days for mild, 8.13% at 21 days for moderate, and 11.55% at 35 days for critical infection. Thromboprophylaxis use in mild, moderate, and critical cases was 5.7%, 28.8%, and 81.7%, respectively. In multivariable analysis, the severity of infection remained the strongest independent predictor of VTE. Compared with mild infection, the relative risk was 8.26 (95% CI, 2.26-30.16) for critical infection and 6.29 (95% CI, 1.54-25.67) for moderate infection.

Conclusion: Overall, VTE incidence in Asian patients with COVID-19 is <1% across successive waves. Patients with moderate and critical infections are at greater risk for VTE and should be considered for routine thromboprophylaxis.

Keywords: Asian; COVID-19; VTE; incidence; venous thromboembolism.