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 / Collaborative, Covidsurg; Collaborative, Globalsurg; Porcu, Alberto; Perra, Teresa; Altana, Cristian; Bussu, Francesco; Capobianco, Giampiero; Giacomina Carta, Anna; Ciccarello, Sandro; Cossu, Maria Laura; Cottu, Pietrina; DE RIU, Giacomo; Dessole, Salvatore; Dessole, Francesco; Dettori, Salvatora; Doria, Carlo; Fancellu, Alessandro; Feo, Claudio; Ginesu, Giorgio Carlo; Giuliani, Giuliana; Giuseppe Iannuccelli, Marco; Madonia, Massimo; Mancino, Roberto; Massarelli, Olindo; Meloni, Gianfranco; Milia, Fabio; Mulliri, Andrea; Petrillo, Marco; Piras, Antonio; Piredda, Franco; Pisanu, Francesco; Rizzo, Davide; Sanna, Angelino; Scanu, Antonio Mario; Scognamillo, Fabrizio; Soma, Damiano; Rita Tanca, Anna; Tedde, Alessandro; Tedde, Matteo; Vaira, Luigi Angelo. - In: ANAESTHESIA. - ISSN 0003-2409. - 77:1(2021), pp. 28-39. [10.1111/anae.15563]
SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study
Alberto PorcuMembro del Collaboration Group
;Teresa PerraMembro del Collaboration Group
;Francesco BussuMembro del Collaboration Group
;Giampiero CapobiancoMembro del Collaboration Group
;Maria Laura CossuMembro del Collaboration Group
;Giacomo De RiuMembro del Collaboration Group
;Salvatore DessoleMembro del Collaboration Group
;Francesco DessoleMembro del Collaboration Group
;Carlo DoriaMembro del Collaboration Group
;Alessandro FancelluMembro del Collaboration Group
;Claudio F FeoMembro del Collaboration Group
;Giorgio Carlo GinesuMembro del Collaboration Group
;Massimo MadoniaMembro del Collaboration Group
;Gianfranco MeloniMembro del Collaboration Group
;Marco PetrilloMembro del Collaboration Group
;Davide RizzoMembro del Collaboration Group
;Antonio Mario ScanuMembro del Collaboration Group
;Fabrizio ScognamilloMembro del Collaboration Group
;Luigi Angelo VairaMembro del Collaboration Group
2021-01-01
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.| File | Dimensione | Formato | |
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