SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study

COVIDSurg Collaborative, GlobalSurg Collaborative, Alexis P Arnaud, José Azevedo, Ana Maria Minaya Bravo, Daoud Chaudhry, Ehab AlAmeer , Kariem El-Boghdadly , Muhammed Elhadi, Sameh Emile, Gaetano Gallo, James C. Glasbey, Dhruva Ghosh , Arda Isik, Conor S Jones, Sezai Leventoğlu, Elizabeth Li, Janet Martin, Helen M. Mohan, Dmitri NepogodievPranay Pawar, Neil J. Smart, Peter Pockney, Joana F.F. Simoes, Stephen Tabiri, Mary L. Venn, Deborah Wright, Aneel Bhangu, Waheed-Ul-Rahman Ahmed, Leah Argus, Alasdair Ball, Edward P Bywater, Ruth Blanco-Colino, Amanpreet Brar, Brett E Dawson, Irani Duran, Rohan R. Gujjuri, Ewen M Harrison , Sivesh K Kamarajah, James M Keatley, Samuel Lawday, Harvinder Mann, Ella J Marson, Kenneth A Mclean, Lisa Norman , Riinu Ots, Oumaima Outani , Maria Picciochi, Irène Santos, Catherine Shaw , Elliott H Taylor, Isobel M Trout, Chris Varghese, William Xu, Irida Dajti, Arben Gjata, Salah Eddine Oussama Kacimi Oussama Kacimi, Luis Boccalatte, Maria Marta Modolo , Daniel Cox, Philip Townend, Felix Aigner, Irmgard Kronberger , Elgun Samadov, Amer Alderazi, Kamral Hossain, Greg Padmore, Gabrielle van Ramshorst, Ismaïl Lawani, Anis Cerovac, Samir Delibegovic, Glauco Baiocchi, Gustavo Mendonça Ataíde Gomes, Igor Lima Buarque, Muhammad Gohar, Mihail Slavchev, Chukwuemeka Nwegbu, Arnav Agarwal, Joshua Ng-Kamstra, Maricarmen Olivos, Wenhui Lou, Dong-Lin Ren, Jose Andres Calvache, Carlos J- Perez Rivera, Ana Danic Hadzibegovic, Tomislav Kopjar, Jakov Mihanovic, Pablo Mijahil Avilés Jiménez, Nikolaos Gouvas, Jaroslav Klat, René Novysedlák, Nicolas Amisi, Peter Christensen, Alaa El-Hussuna, Sylvia Batista, Eddy Lincango-Naranjo, Danilo Alfonso Arévalo Sandoval, Hailu Dhufera, Mengistu Gebreyohanes Mengesha , Joonas H. Kauppila, Zaza Demetrashvili, Markus Albertsmeier, Hans Lederhuber, Markus W. Löffler, Daniel Kwesi Acquah, Bernard Ofori, Symeon Metallidis, Georgios Tsoulfas, Maria-Lorena Aguilera-Arevalo, Gustavo Recinos, Tamás Mersich, Dániel Wettstein, Gabriele Kembuan, Peiman Brouki Milan, Mohammad Hossein Khosravi, Masoud Mozafari, Ahmed Hilmi, Oded Zmora, Francesco Pata, Gianluca Pellino, Yuki Fujimoto, Naoto Kuroda, Sohei Satoi , Mohamad K. Abou Chaar, Faris Ayasra, Ildar Fakhradiyev, Intisar Hisham Said Hamdun, Jang Jin-Young, Mohammad Jamal, Lina Karout, Aiste Gulla, Fanjandrainy Rasoaherinomenjanahary, Luc Hervé Samison, April Camilla Roslani , Iran Irani Durán Sánchez, Diana Samantha Gonzalez, Laura Martinez, María José Martínez, Alejandra Nayen, Antonio Ramos-De la Medina, Jade Nunez, Pueya Rashid Nashidengo, Rakesh Shah, Ashish Lal Shrestha, Pascal Jonker, Schelto Kruijff, Milou Noltes, Pieter Steinkamp, Lukman Abdur-Rahman, Adesoji Ademuyiwa, Adewale Adisa, Babatunde Osinaike, Justina Seyi-Olajide, Omolara Williams, Emmanuel Williams, Sofija Pejkova, Zainab Al Balushi, Ahmad Uzair Qureshi , Raza Sayyed, Mustafa Abo Mohsen, Sadi A. Abukhalaf, Moises Cukier, Hugo Gomez-Fernandez, Sebastian Shu Yip, Ximena Paola Vasquez Ojeda, Marie Dione Sacdalan, Piotr Major, Miguel F. Cunha, Ahmad Zarour, Eduard-Alexandru Bonci, Ionut Negoi, Sergey Efetov, Viktor Kochetkov, Andrey Litvin, Jc Allen Ingabire, Georges Bucyibaruta, Ntirenganya Faustin, Sosthene Habumuremyi, Alphonsine Imanishimwe, Haragirimana Jean de Dieu, Emmanuel Munyaneza, Isaie Ncogoza, Abdourahmane Ndong, Dejan Radenkovic, Min Hoe Chew, Frederick Koh, James Ngu, Arpád Panyko, Uros Bele, Jurij Aleš Košir, Hassan Daoud, Umesh Jayarajah, Dakshitha Wickramasinghe, Mohammed Elmujtba Adam Essa Adam, Martin Rutegård, Malin Sund, Michel Adamina, Melika Akhbari, Ruth Benson, Shivam Bhanderi, Bruce Biccard, Edward Caruana, Sohini Chakrabortee, Reema Chapatwala, Ainhoa Costas-Chavarri, Andreas K Demetriades, Anant Desai, Salomone Di Saverio, Thomas M. Drake, John Edwards, Jonathan P. Evans, Marco Fiore, Samuel J. Ford, Christina Fotopoulou, Alexander Fowler, Kaori Futaba, Ian Ganly, Harelimana Grace James, Ewen Griffiths, Alessandro Gronchi, Peter Hutchinson, Gabriella Yael Hyman, Joseph Incorvia, Ritu Jain, Michael Jenkinson, Tabassum Khan, Stephen Richard Knight, Angelos G. Kolias, Søren Kudsk-Iversen, Tsun Yu Kwan, Elaine Leung, Julio Mayol, Siobhan C. McKay, John G. Meara, Emily Mills, S. Moug, A Patel, Roberto Perinotti, Henry Rice, Keith J. Roberts, Andrew Schache, Richard Shaw, Matthew Stephens, Grant D. Stewart, Ella Teasdale, Peter Vaughan-Shaw, Raghavan Vidya, Naomi Wright, Funmilola Wuraola , David Watson, Tim Bright, Paul Hollington

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Number of pages12
JournalAnaesthesia
Early online date24 Aug 2021
DOIs
Publication statusE-pub ahead of print - 24 Aug 2021

Keywords

  • COVID-19
  • deep vein thrombosis
  • pulmonary embolism
  • SARS-CoV-2
  • venous thromboembolism

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