SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1–2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2–3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9–3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3–6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.
SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study / Nepogodiev, Dmitri; Ff Simoes, Joana; Li, Elizabeth; Picciochi, Maria; C Glasbey, James; Baiocchi, Glauco; Blanco-Colino, Ruth; Chaudhry, Daoud; Alameer, Ehab; El-Boghdadly, Kariem; Wuraola, Funmilola; Ghosh, Dhruva; R Gujjuri, Rohan; M Harrison, Ewen; Lule, Herman; Kaafarani, Haytham; Khosravi, Mohammad; Kronberger, Irmgard; Leventoğlu, Sezai; Mann, Harvinder; A Mclean, Kenneth; Gebreyohanes Mengesha, Mengistu; Marta Modolo, Maria; Ntirenganya, Faustin; Norman, Lisa; Outani, Oumaima; Pius, Riinu; Pockney, Peter; Uzair Qureshi, Ahmad; Camilla Roslani, April; Satoi, Sohei; Shaw, Catherine; Bhangu, Aneel; Nepogodiev, Dmitri; Omar, M Omar; Ahmed, Waheed-Ul-Rahman; Argus, Leah; Ball, Alasdair; Bhangu, Aneel; P Bywater, Edward; Blanco-Colino, Ruth; Brar, Amanpreet; Chaudhry, Daoud; E Dawson, Brett; Duran, Irani; Elhadi, Muhammed; C Glasbey, James; R Gujjuri, Rohan; S Jones, Conor; M Harrison, Ewen; K Kamarajah, Sivesh; M Keatley, James; Lawday, Samuel; Li, Elizabeth; Mann, Harvinder; J Marson, Ella; A Mclean, Kenneth; Nepogodiev, Dmitri; Norman, Lisa; Ots, Riinu; Outani, Oumaima; Picciochi, Maria; Santos, Irène; Shaw, Catherine; Ff Simoes, Joana; H Taylor, Elliott; M Trout, Isobel; Varghese, Chris; L Venn, Mary; Xu, William; Ff Simoes, Joana; Dajti, Irida; Gjata, Arben; Eddine Oussama Kacimi, Salah; Boccalatte, Luis; Marta Modolo, Maria; Cox, Daniel; Pockney, Peter; Townend, Philip; Aigner, Felix; Elisabeth Kronberger, Irmgard; Samadov, Elgun; Alderazi, Amer; Hossain, Kamral; Padmore, Greg; van Ramshorst, Gabrielle; Lawani, Ismaïl; Cerovac, Anis; Delibegovic, Samir; Baiocchi, Glauco; Mendonça Ataíde Gomes, Gustavo; Lima Buarque, Igor; Gohar, Muhammad; Slavchev, Mihail; Nwegbu, Chukwuemeka; Agarwal, Arnav; Brar, Amanpreet; Martin, Janet; Ng-Kamstra, Joshua; Marta Modolo, Maria; Olivos, Maricarmen; Lou, Wenhui; Ren, Dong-Lin; Andres Calvache, Jose; J Perez Rivera, Carlos; Danic Hadzibegovic, Ana; Kopjar, Tomislav; Mihanovic, Jakov; Mijahil Avilés Jiménez, Pablo; Gouvas, Nikolaos; Klat, Jaroslav; Novysedlák, René; Amisi, Nicolas; Christensen, Peter; El-Hussuna, Alaa; Batista, Sylvia; Lincango-Naranjo, Eddy; Emile, Sameh; Alfonso Arévalo Sandoval, Danilo; Dhufera, Hailu; Hailu, Samuel; G Mengesha, Mengistu; H Kauppila, Joonas; P Arnaud, Alexis; Demetrashvili, Zaza; Albertsmeier, Markus; Lederhuber, Hans; W Löffler, Markus; Kwesi Acquah, Daniel; Ofori, Bernard; Tabiri, Stephen; Metallidis, Symeon; Tsoulfas, Georgios; Aguilera-Arevalo, Maria-Lorena; Recinos, Gustavo; Mersich, Tamás; Wettstein, Dániel; Ghosh, Dhruva; Kembuan, Gabriele; Brouki Milan, Peiman; Hossein Khosravi, Mohammad; Mozafari, Masoud; Hilmi, Ahmed; Mohan, Helen; Zmora, Oded; Gallo, Gaetano; Pata, Francesco; Pellino, Gianluca; Fujimoto, Yuki; Kuroda, Naoto; Satoi, Sohei; K Abou Chaar, Mohamad; Ayasra, Faris; Fakhradiyev, Ildar; Hisham Said Hamdun, Intisar; Jin-Young, Jang; Jamal, Mohammad; Karout, Lina; Elhadi, Muhammed; Gulla, Aiste; Rasoaherinomenjanahary, Fanjandrainy; Hervé Samison, Luc; Camilla Roslani, April; Irani Durán Sánchez, Iran; Samantha Gonzalez, Diana; Martinez, Laura; José Martínez, María; Nayen, Alejandra; Ramos-De la Medina, Antonio; Nunez, Jade; Outani, Oumaima; Rashid Nashidengo, Pueya; Shah, Rakesh; Lal Shrestha, Ashish; Jonker, Pascal; Kruijff, Schelto; Noltes, Milou; Steinkamp, Pieter; Varghese, Chris; Wright, Deborah; Abdur-Rahman, Lukman; Ademuyiwa, Adesoji; Adisa, Adewale; Osinaike, Babatunde; Seyi-Olajide, Justina; Williams, Omolara; Williams, Emmanuel; Pejkova, Sofija; Al Balushi, Zainab; Uzair Qureshi, Ahmad; Sayyed, Raza; Abo Mohsen, Mustafa; A Abukhalaf, Sadi; Cukier, Moises; Gomez-Fernandez, Hugo; Shu Yip, Sebastian; Paola Vasquez Ojeda, Ximena; Dione Sacdalan, Marie; Major, Piotr; Azevedo, José; F Cunha, Miguel; Santos, Irène; Zarour, Ahmad; Bonci, Eduard-Alexandru; Negoi, Ionut; Efetov, Sergey; Kochetkov, Viktor; Litvin, Andrey; Allen Ingabire, Jc; Bucyibaruta, Georges; Faustin, Ntirenganya; Habumuremyi, Sosthene; Imanishimwe, Alphonsine; Jean de Dieu, Haragirimana; Munyaneza, Emmanuel; Ncogoza, Isaie; Alameer, Ehab; Ndong, Abdourahmane; Radenkovic, Dejan; Hoe Chew, Min; Koh, Frederick; Ngu, James; Panyko, Arpád; Bele, Uros; Aleš Košir, Jurij; Daoud, Hassan; Blanco-Colino, Ruth; Maria Minaya Bravo, Ana; Jayarajah, Umesh; Wickramasinghe, Dakshitha; Elmujtba Adam Essa Adam, Mohammed; Rutegård, Martin; Sund, Malin; Adamina, Michel; Gialamas, Eleftherios; Horisberger, Karoline; Alshaar, Muhammad; Huang, Abel; Lohsiriwat, Varut; Charles, Shane; Jlassi, Haithem; Isik, Arda; Leventoğlu, Sezai; Monka Lekuya, Hervé; Monka Lekuya, Hervé; Lule, Herman; Kopetskyi, Slava; Alsaadi, Hayder; Alshryda, Sattar; Alser, Osaid; Bankhead-Kendall, Brittany; Breen, Kerry; Kaafarani, Haytham; Mashbari, Hassan; Bonilla Cal, Fernando; Al-Naggar, Hamza; Maimbo, Mayaba; Mazingi, Dennis; Abbott, Tom; Adamina, Michel; Akhbari, Melika; Benson, Ruth; Bhanderi, Shivam; Biccard, Bruce; Caruana, Edward; Chakrabortee, Sohini; Chapatwala, Reema; Costas-Chavarri, Ainhoa; K Demetriades, Andreas; Desai, Anant; Di Saverio, Salomone; Drake, Thomas; Edwards, John; Evans, Jonathan; Fiore, Marco; Ford, Samuel; Fotopoulou, Christina; Fowler, Alexander; Futaba, Kaori; Ganly, Ian; Grace James, Harelimana; Griffiths, Ewen; Gronchi, Alessandro; Hutchinson, Peter; Yael Hyman, Gabriella; Incorvia, Joseph; Jain, Ritu; Jenkinson, Michael; Khan, Tabassum; Richard Knight, Stephen; Kolias, Angelos; Kudsk-Iversen, Søren; Yu Kwan, Tsun; Leung, Elaine; Mayol, Julio; Mckay, Siobhan; G Meara, John; Mills, Emily; Moug, Susan; Patel, Akshay; Perinotti, Roberto; E Rice, Henry; Roberts, Keith; Schache, Andrew; Shaw, Richard; Smart, Neil; Stephens, Matthew; D Stewart, Grant; Teasdale, Ella; Vaughan-Shaw, Peter; Vidya, Raghavan; Wright, Naomi; Wuraola, Funmilola; Zimmelman, Natalie; Agastra, Ervis; Thereska, Dariel; Dajti, Irida; Martin Lucchini, Sergio; Laudani, Veronica; Boccalatte, Luis; Chwat, Carina; Ines Pedraza Salazar, Ivana; Alejandra Pantoja Pachajoa, Diana; Martin Lucchini, Sergio; Duro, Agustin; Alfredo Calderón Arancibia, José; Cox, Daniel; D'Aulerio, Giuliana; Dudi-Venkata, Nagendra; Egoroff, Natasha; Farik, Shebani; Lott, Natalie; Moss, Jana-Lee; Rennie, Sarah; Tan, Lorwai; Varghese, Chris; Giao Vo, Uyen; Watson, David; Watters, David; Wright, Deborah; Bright, Tim; Hollington, Paul; Zhou, Xuanyu; M Kroon, Hidde; Farfus, Anthony; Barker, John; Watson, Eleanor; Stevens, Sean; Latif, Haider; Caroline Dawson, Amanda; Chuan, Alwin; Muralidharan, Vijayaragavan; Wong, Enoch; Ackermann, Travis; Pacilli, Maurizio; Hodgson, Russell; Heriot, Alexander; Choong, Peter; Brown, Wendy; Lidder, Surjit; Yeung, Justin; Traeger, Luke; Regalo, Guillermo; Gourlay, Ralph; Pockney, Peter; Pockney, Peter; Badiani, Sarit; Koh, Cherry; Putnis, Soni; Caroline Dawson, Amanda; Haider, Fayza; Rahman Mitul, Ashrarur; Komen, Niels; Dhondt, Bert; Cappeliez, Serge; Pigeolet, Manon; van Ramshorst, Gabrielle; 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[10.1111/anae.15563]
SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study
Renato CostiMembro del Collaboration Group
;Edoardo VirgilioMembro del Collaboration Group
;Pietro ManiscalcoMembro del Collaboration Group
;
2022-01-01
Abstract
SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1–2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2–3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9–3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3–6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
