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

COVIDSurg Collaborative; GlobalSurg Collaborative

doi:10.1111/anae.15563

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

COVIDSurg Collaborative, GlobalSurg Collaborative

Research output: Contribution to journal › Article › Research › peer-review

94 Citations (Scopus)

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 language	English
Pages (from-to)	28-39
Number of pages	12
Journal	Anaesthesia
Volume	77
Issue number	1
DOIs	https://doi.org/10.1111/anae.15563
Publication status	Published - Jan 2022
Externally published	Yes

Keywords

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

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10.1111/anae.15563Licence: CC BY

Cite this

@article{9aef4e34a4d0418cb558bcd4cf4db60c,

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

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.",

keywords = "COVID-19, deep vein thrombosis, pulmonary embolism, SARS-CoV-2, venous thromboembolism",

author = "Dmitri Nepogodiev and Simoes, {Joana F.F.} and Elizabeth Li and Maria Picciochi and Glasbey, {James C.} and Glauco Baiocchi and Ruth Blanco-Colino and Daoud Chaudhry and Ehab AlAmeer and Kariem El-Boghdadly and Funmilola Wuraola and Dhruva Ghosh and Gujjuri, {Rohan R.} and Harrison, {Ewen M.} and Herman Lule and Haytham Kaafarani and Khosravi, {Mohammad Hossein} and Kronberger, {Irmgard Elisabeth} and Sezai Leventoglu and Harvinder Mann and Mclean, {Kenneth A.} and Mengesha, {Mengistu G.} and Modolo, {Maria Marta} and Faustin Ntirenganya and Lisa Norman and Oumaima Outani and Riinu Pius and Peter Pockney and Qureshi, {Ahmad Uzair} and Roslani, {April Camilla} and Sohei Satoi and Catherine Shaw and Aneel Bhangu and Omar, {Omar M.} and Ahmed, {Waheed Ul Rahman} and Leah Argus and Alasdair Ball and Bywater, {Edward P.} and Amanpreet Brar and Dawson, {Brett E.} and Irani Duran and Muhammed Elhadi and Jones, {Conor S.} and Kamarajah, {Sivesh K.} and Keatley, {James M.} and Samuel Lawday and Marson, {Ella J.} and Riinu Ots and Ir{\`e}ne Santos and Taylor, {Elliott H.} and Trout, {Isobel M.} and Chris Varghese and Venn, {Mary L.} and William Xu and Irida Dajti and Arben Gjata and Kacimi, {Salah Eddine Oussama} and Luis Boccalatte and Daniel Cox and Philip Townend and Felix Aigner and Kronberger, {Irmgard Elisabeth} and Elgun Samadov and Amer Alderazi and Kamral Hossain and Greg Padmore and {van Ramshorst}, Gabrielle and Isma{\"i}l Lawani and Anis Cerovac and Samir Delibegovic and Gomes, {Gustavo Mendon{\c c}a Ata{\'i}de} and Buarque, {Igor Lima} and Muhammad Gohar and Mihail Slavchev and Chukwuemeka Nwegbu and Arnav Agarwal and Janet Martin and Joshua Ng-Kamstra and Maricarmen Olivos and Wenhui Lou and Ren, {Dong Lin} and Calvache, {Jose Andres} and {Perez Rivera}, {Carlos J.} and Hadzibegovic, {Ana Danic} and Tomislav Kopjar and Jakov Mihanovic and Jim{\'e}nez, {Pablo Mijahil Avil{\'e}s} and Nikolaos Gouvas and Jaroslav Klat and Ren{\'e} Novysedl{\'a}k and Nicolas Amisi and Peter Christensen and Alaa El-Hussuna and Sylvia Batista and Eddy Lincango-Naranjo and Sameh Emile and Sandoval, {Danilo Alfonso Ar{\'e}valo} and Hailu Dhufera and Samuel Hailu and Mengesha, {Mengistu G.} and Kauppila, {Joonas H.} and Arnaud, {Alexis P.} and Zaza Demetrashvili and Markus Albertsmeier and Hans Lederhuber and L{\"o}ffler, {Markus W.} and Acquah, {Daniel Kwesi} and Bernard Ofori and Stephen Tabiri and Symeon Metallidis and Georgios Tsoulfas and Aguilera-Arevalo, {Maria Lorena} and Gustavo Recinos and Tam{\'a}s Mersich and D{\'a}niel Wettstein and Gabriele Kembuan and Milan, {Peiman Brouki} and Khosravi, {Mohammad Hossein} and Masoud Mozafari and Ahmed Hilmi and Helen Mohan and Oded Zmora and Gaetano Gallo and Francesco Pata and Gianluca Pellino and Yuki Fujimoto and Naoto Kuroda and {Abou Chaar}, {Mohamad K.} and Faris Ayasra and Ildar Fakhradiyev and Hamdun, {Intisar Hisham Said} and Jang Jin-Young and Mohammad Jamal and Lina Karout and Aiste Gulla and Fanjandrainy Rasoaherinomenjanahary and Samison, {Luc Herv{\'e}} and S{\'a}nchez, {Iran Irani Dur{\'a}n} and Gonzalez, {Diana Samantha} and Laura Martinez and Mart{\'i}nez, {Mar{\'i}a Jos{\'e}} and Alejandra Nayen and {la Medina}, {Antonio Ramos De} and Jade Nunez and Nashidengo, {Pueya Rashid} and Rakesh Shah and Shrestha, {Ashish Lal} and Pascal Jonker and Schelto Kruijff and Milou Noltes and Pieter Steinkamp and Deborah Wright and Lukman Abdur-Rahman and Adesoji Ademuyiwa and Adewale Adisa and Babatunde Osinaike and Justina Seyi-Olajide and Omolara Williams and Emmanuel Williams and Sofija Pejkova and {Al Balushi}, Zainab and Raza Sayyed and Mohsen, {Mustafa Abo} and Abukhalaf, {Sadi A.} and Moises Cukier and Hugo Gomez-Fernandez and Yip, {Sebastian Shu} and Ojeda, {Ximena Paola Vasquez} and Sacdalan, {Marie Dione} and Piotr Major and Jos{\'e} Azevedo and Cunha, {Miguel F.} and Ahmad Zarour and Bonci, {Eduard Alexandru} and Ionut Negoi and Sergey Efetov and Viktor Kochetkov and Andrey Litvin and Ingabire, {Jc Allen} and Georges Bucyibaruta and Ntirenganya Faustin and Sosthene Habumuremyi and Alphonsine Imanishimwe and {de Dieu}, {Haragirimana Jean} and Emmanuel Munyaneza and Isaie Ncogoza and Abdourahmane Ndong and Dejan Radenkovic and Chew, {Min Hoe} and Frederick Koh and James Ngu and Arp{\'a}d Panyko and Uros Bele and Ko{\v s}ir, {Jurij Ale{\v s}} and Hassan Daoud and Bravo, {Ana Maria Minaya} and Umesh Jayarajah and Dakshitha Wickramasinghe and Adam, {Mohammed Elmujtba Adam Essa} and Martin Ruteg{\aa}rd and Malin Sund and Michel Adamina and Eleftherios Gialamas and Karoline Horisberger and Muhammad Alshaar and Abel Huang and Varut Lohsiriwat and Shane Charles and Haithem Jlassi and Arda Isik and Lekuya, {Herv{\'e} Monka} and Slava Kopetskyi and Hayder Alsaadi and Sattar Alshryda and Osaid Alser and Brittany Bankhead-Kendall and Kerry Breen and Hassan Mashbari and Cal, {Fernando Bonilla} and Hamza Al-Naggar and Mayaba Maimbo and Dennis Mazingi and Tom Abbott and Melika Akhbari and Ruth Benson and Shivam Bhanderi and Bruce Biccard and Edward Caruana and Sohini Chakrabortee and Reema Chapatwala and Ainhoa Costas-Chavarri and Demetriades, {Andreas K.} and Anant Desai and {Di Saverio}, Salomone and Thomas Drake and John Edwards and Jonathan Evans and Marco Fiore and Samuel Ford and Christina Fotopoulou and Alexander Fowler and Kaori Futaba and Ian Ganly and James, {Harelimana Grace} and Maurizio Pacilli and Joshua Kealey and Nora Mutalima and Ramesh Nataraja and Adrian Fox and Toby Richards and {COVIDSurg Collaborative} and {GlobalSurg Collaborative}",

note = "Funding Information: This study was registered prospectively at clinicaltrials.gov (NCT04509986). Funding was provided by: National Institute for Health Research (NIHR) Global Health Research Unit; Association of Coloproctology of Great Britain and Ireland; Bowel and Cancer Research; Bowel Disease Research Foundation; Association of Upper Gastrointestinal Surgeons; British Association of Surgical Oncology; British Gynaecological Cancer Society; European Society of Coloproctology; Medtronic; NIHR Academy; Sarcoma UK; The Urology Foundation; Vascular Society for Great Britain and Ireland; and Yorkshire Cancer Research. The views expressed are those of the authors and not necessarily those of the funding partners. No other competing interests declared. Publisher Copyright: {\textcopyright} 2021 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.",

year = "2022",

month = jan,

doi = "10.1111/anae.15563",

language = "English",

volume = "77",

pages = "28--39",

journal = "Anaesthesia",

issn = "0003-2409",

publisher = "Wiley-Blackwell",

number = "1",

}

TY - JOUR

T1 - SARS-CoV-2 infection and venous thromboembolism after surgery

T2 - an international prospective cohort study

AU - Nepogodiev, Dmitri

AU - Simoes, Joana F.F.

AU - Li, Elizabeth

AU - Picciochi, Maria

AU - Glasbey, James C.

AU - Baiocchi, Glauco

AU - Blanco-Colino, Ruth

AU - Chaudhry, Daoud

AU - AlAmeer, Ehab

AU - El-Boghdadly, Kariem

AU - Wuraola, Funmilola

AU - Ghosh, Dhruva

AU - Gujjuri, Rohan R.

AU - Harrison, Ewen M.

AU - Lule, Herman

AU - Kaafarani, Haytham

AU - Khosravi, Mohammad Hossein

AU - Kronberger, Irmgard Elisabeth

AU - Leventoglu, Sezai

AU - Mann, Harvinder

AU - Mclean, Kenneth A.

AU - Mengesha, Mengistu G.

AU - Modolo, Maria Marta

AU - Ntirenganya, Faustin

AU - Norman, Lisa

AU - Outani, Oumaima

AU - Pius, Riinu

AU - Pockney, Peter

AU - Qureshi, Ahmad Uzair

AU - Roslani, April Camilla

AU - Satoi, Sohei

AU - Shaw, Catherine

AU - Bhangu, Aneel

AU - Omar, Omar M.

AU - Ahmed, Waheed Ul Rahman

AU - Argus, Leah

AU - Ball, Alasdair

AU - Bywater, Edward P.

AU - Brar, Amanpreet

AU - Dawson, Brett E.

AU - Duran, Irani

AU - Elhadi, Muhammed

AU - Jones, Conor S.

AU - Kamarajah, Sivesh K.

AU - Keatley, James M.

AU - Lawday, Samuel

AU - Marson, Ella J.

AU - Ots, Riinu

AU - Santos, Irène

AU - Taylor, Elliott H.

AU - Trout, Isobel M.

AU - Varghese, Chris

AU - Venn, Mary L.

AU - Xu, William

AU - Dajti, Irida

AU - Gjata, Arben

AU - Kacimi, Salah Eddine Oussama

AU - Boccalatte, Luis

AU - Cox, Daniel

AU - Townend, Philip

AU - Aigner, Felix

AU - Kronberger, Irmgard Elisabeth

AU - Samadov, Elgun

AU - Alderazi, Amer

AU - Hossain, Kamral

AU - Padmore, Greg

AU - van Ramshorst, Gabrielle

AU - Lawani, Ismaïl

AU - Cerovac, Anis

AU - Delibegovic, Samir

AU - Gomes, Gustavo Mendonça Ataíde

AU - Buarque, Igor Lima

AU - Gohar, Muhammad

AU - Slavchev, Mihail

AU - Nwegbu, Chukwuemeka

AU - Agarwal, Arnav

AU - Martin, Janet

AU - Ng-Kamstra, Joshua

AU - Olivos, Maricarmen

AU - Lou, Wenhui

AU - Ren, Dong Lin

AU - Calvache, Jose Andres

AU - Perez Rivera, Carlos J.

AU - Hadzibegovic, Ana Danic

AU - Kopjar, Tomislav

AU - Mihanovic, Jakov

AU - Jiménez, Pablo Mijahil Avilés

AU - Gouvas, Nikolaos

AU - Klat, Jaroslav

AU - Novysedlák, René

AU - Amisi, Nicolas

AU - Christensen, Peter

AU - El-Hussuna, Alaa

AU - Batista, Sylvia

AU - Lincango-Naranjo, Eddy

AU - Emile, Sameh

AU - Sandoval, Danilo Alfonso Arévalo

AU - Dhufera, Hailu

AU - Hailu, Samuel

AU - Mengesha, Mengistu G.

AU - Kauppila, Joonas H.

AU - Arnaud, Alexis P.

AU - Demetrashvili, Zaza

AU - Albertsmeier, Markus

AU - Lederhuber, Hans

AU - Löffler, Markus W.

AU - Acquah, Daniel Kwesi

AU - Ofori, Bernard

AU - Tabiri, Stephen

AU - Metallidis, Symeon

AU - Tsoulfas, Georgios

AU - Aguilera-Arevalo, Maria Lorena

AU - Recinos, Gustavo

AU - Mersich, Tamás

AU - Wettstein, Dániel

AU - Kembuan, Gabriele

AU - Milan, Peiman Brouki

AU - Khosravi, Mohammad Hossein

AU - Mozafari, Masoud

AU - Hilmi, Ahmed

AU - Mohan, Helen

AU - Zmora, Oded

AU - Gallo, Gaetano

AU - Pata, Francesco

AU - Pellino, Gianluca

AU - Fujimoto, Yuki

AU - Kuroda, Naoto

AU - Abou Chaar, Mohamad K.

AU - Ayasra, Faris

AU - Fakhradiyev, Ildar

AU - Hamdun, Intisar Hisham Said

AU - Jin-Young, Jang

AU - Jamal, Mohammad

AU - Karout, Lina

AU - Gulla, Aiste

AU - Rasoaherinomenjanahary, Fanjandrainy

AU - Samison, Luc Hervé

AU - Sánchez, Iran Irani Durán

AU - Gonzalez, Diana Samantha

AU - Martinez, Laura

AU - Martínez, María José

AU - Nayen, Alejandra

AU - la Medina, Antonio Ramos De

AU - Nunez, Jade

AU - Nashidengo, Pueya Rashid

AU - Shah, Rakesh

AU - Shrestha, Ashish Lal

AU - Jonker, Pascal

AU - Kruijff, Schelto

AU - Noltes, Milou

AU - Steinkamp, Pieter

AU - Wright, Deborah

AU - Abdur-Rahman, Lukman

AU - Ademuyiwa, Adesoji

AU - Adisa, Adewale

AU - Osinaike, Babatunde

AU - Seyi-Olajide, Justina

AU - Williams, Omolara

AU - Williams, Emmanuel

AU - Pejkova, Sofija

AU - Al Balushi, Zainab

AU - Sayyed, Raza

AU - Mohsen, Mustafa Abo

AU - Abukhalaf, Sadi A.

AU - Cukier, Moises

AU - Gomez-Fernandez, Hugo

AU - Yip, Sebastian Shu

AU - Ojeda, Ximena Paola Vasquez

AU - Sacdalan, Marie Dione

AU - Major, Piotr

AU - Azevedo, José

AU - Cunha, Miguel F.

AU - Zarour, Ahmad

AU - Bonci, Eduard Alexandru

AU - Negoi, Ionut

AU - Efetov, Sergey

AU - Kochetkov, Viktor

AU - Litvin, Andrey

AU - Ingabire, Jc Allen

AU - Bucyibaruta, Georges

AU - Faustin, Ntirenganya

AU - Habumuremyi, Sosthene

AU - Imanishimwe, Alphonsine

AU - de Dieu, Haragirimana Jean

AU - Munyaneza, Emmanuel

AU - Ncogoza, Isaie

AU - Ndong, Abdourahmane

AU - Radenkovic, Dejan

AU - Chew, Min Hoe

AU - Koh, Frederick

AU - Ngu, James

AU - Panyko, Arpád

AU - Bele, Uros

AU - Košir, Jurij Aleš

AU - Daoud, Hassan

AU - Bravo, Ana Maria Minaya

AU - Jayarajah, Umesh

AU - Wickramasinghe, Dakshitha

AU - Adam, Mohammed Elmujtba Adam Essa

AU - Rutegård, Martin

AU - Sund, Malin

AU - Adamina, Michel

AU - Gialamas, Eleftherios

AU - Horisberger, Karoline

AU - Alshaar, Muhammad

AU - Huang, Abel

AU - Lohsiriwat, Varut

AU - Charles, Shane

AU - Jlassi, Haithem

AU - Isik, Arda

AU - Lekuya, Hervé Monka

AU - Kopetskyi, Slava

AU - Alsaadi, Hayder

AU - Alshryda, Sattar

AU - Alser, Osaid

AU - Bankhead-Kendall, Brittany

AU - Breen, Kerry

AU - Mashbari, Hassan

AU - Cal, Fernando Bonilla

AU - Al-Naggar, Hamza

AU - Maimbo, Mayaba

AU - Mazingi, Dennis

AU - Abbott, Tom

AU - Akhbari, Melika

AU - Benson, Ruth

AU - Bhanderi, Shivam

AU - Biccard, Bruce

AU - Caruana, Edward

AU - Chakrabortee, Sohini

AU - Chapatwala, Reema

AU - Costas-Chavarri, Ainhoa

AU - Demetriades, Andreas K.

AU - Desai, Anant

AU - Di Saverio, Salomone

AU - Drake, Thomas

AU - Edwards, John

AU - Evans, Jonathan

AU - Fiore, Marco

AU - Ford, Samuel

AU - Fotopoulou, Christina

AU - Fowler, Alexander

AU - Futaba, Kaori

AU - Ganly, Ian

AU - James, Harelimana Grace

AU - Pacilli, Maurizio

AU - Kealey, Joshua

AU - Mutalima, Nora

AU - Nataraja, Ramesh

AU - Fox, Adrian

AU - Richards, Toby

AU - COVIDSurg Collaborative

AU - GlobalSurg Collaborative

N1 - Funding Information: This study was registered prospectively at clinicaltrials.gov (NCT04509986). Funding was provided by: National Institute for Health Research (NIHR) Global Health Research Unit; Association of Coloproctology of Great Britain and Ireland; Bowel and Cancer Research; Bowel Disease Research Foundation; Association of Upper Gastrointestinal Surgeons; British Association of Surgical Oncology; British Gynaecological Cancer Society; European Society of Coloproctology; Medtronic; NIHR Academy; Sarcoma UK; The Urology Foundation; Vascular Society for Great Britain and Ireland; and Yorkshire Cancer Research. The views expressed are those of the authors and not necessarily those of the funding partners. No other competing interests declared. Publisher Copyright: © 2021 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.

PY - 2022/1

Y1 - 2022/1

N2 - 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.

AB - 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.

KW - COVID-19

KW - deep vein thrombosis

KW - pulmonary embolism

KW - SARS-CoV-2

KW - venous thromboembolism

UR - http://www.scopus.com/inward/record.url?scp=85122545923&partnerID=8YFLogxK

U2 - 10.1111/anae.15563

DO - 10.1111/anae.15563

M3 - Article

C2 - 34428858

AN - SCOPUS:85122545923

SN - 0003-2409

VL - 77

SP - 28

EP - 39

JO - Anaesthesia

JF - Anaesthesia

IS - 1

ER -

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

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Keywords

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