Dr. Sullivan
Clinical question: How long should anticoagulation be continued after COVID-19-associated venous thromboembolism (VTE)?
Background: COVID-19 infection is associated with an increased risk of VTE; however, it is unclear if the risk is transient or ongoing. Understanding the risk of recurrence would help guide decisions on the duration of anticoagulation.
Study design: Prospective cohort study
Setting: Data from the Registro Informatizado de la Enfermedad, a multinational database registry of patients with VTE and other thrombotic conditions
Synopsis: 431 patients in the registry with COVID-19-associated VTE who had undergone at least 3 months of anticoagulation therapy were followed up at a median of 5.8 months for symptomatic recurrent VTE after discontinuing anticoagulation. There was a 4.8 per 100 patient-years rate of recurrent VTE in these patients, which is similar to previously reported rates of recurrent VTE following the discontinuation of anticoagulation after a single, non-surgical, provoked VTE.
This suggests that the hypercoagulable state associated with COVID-19 is limited and providing a short course of anticoagulation to patients with COVID-19-associated VTE as opposed to an extended course is optimal.
Bottom line: Patients with a single COVID-19-associated VTE are at low risk for recurrence following a short course of anticoagulation.
Citation: Jara-Palomares L, et al. Rate of recurrence after discontinuing anticoagulation therapy in patients with COVID-19-associated venous thromboembolism. JAMA Intern Med. 2022;182(12):1326-28.
Dr. Sullivan is an academic hospitalist at Richmond Veterans Affairs Medical Center and an assistant professor of medicine at Virginia Commonwealth University in Richmond, Va.