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

ContributorsCOVIDSurg Collaborative; GlobalSurg Collaborative
CollaboratorsWildhaber, Barbara
Published inAnaesthesia, vol. 77, no. 1, p. 28-39
Publication date2022-01
First online date2021-08-24
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
  • SARS-CoV-2
  • Deep vein thrombosis
  • Pulmonary embolism
  • Venous thromboembolism
  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • COVID-19 / complications
  • Cohort Studies
  • Female
  • Humans
  • Internationality
  • Male
  • Middle Aged
  • Postoperative Complications / etiology
  • Prospective Studies
  • Sex Distribution
  • Venous Thromboembolism / etiology
  • Young Adult
Funding
  • Pancreatic Cancer UK [2018RIF_06]
  • British Heart Foundation [CH/17/1/32804]
  • British Heart Foundation [PG/15/33/31394]
  • NIDDK NIH HHS [T32 DK060442]
  • National Institute for Health Research (NIHR) [CL-2019-11-502]
  • The Sir Jules Thorn Charitable Trust [14/JTA]
  • Academy of Medical Sciences [AMS-SGCL13-Saratzis]
  • Cancer Research UK [S_4303]
Citation (ISO format)
COVIDSurg Collaborative, GlobalSurg Collaborative. SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study. In: Anaesthesia, 2022, vol. 77, n° 1, p. 28–39. doi: 10.1111/anae.15563
Main files (1)
Article (Published version)
Secondary files (3)
Appendix - Appendix S1. COVIDSurg Collaborative authors
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Appendix - Appendix S2. Definitions of terms used in this study
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Supplemental data - Tables S1-S7
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Identifiers
Journal ISSN0003-2409
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Technical informations

Creation03/10/2022 09:13:21
First validation23/11/2023 18:10:11
Update23/11/2023 18:10:11
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