Pulmonary embolism and deep venous thrombosis after COVID-19: long-term risk in a population-based cohort study

Helen Sjoland; Martin Lindgren; Triantafyllia Toska; Per-Olof Hansson; Katarina Glise Sandblad; Christian Alex; Lena Bjorck; Ottmar Cronie; Jonas Bjork; Christina E Lundberg; Martin Adiels; Annika Rosengren

doi:10.1016/j.rpth.2023.100284

Pulmonary embolism and deep venous thrombosis after COVID-19: long-term risk in a population-based cohort study

Res Pract Thromb Haemost. 2023 Jun 21;7(5):100284. doi: 10.1016/j.rpth.2023.100284. Online ahead of print.

Authors

Helen Sjoland^{1

2}, Martin Lindgren^{1

2}, Triantafyllia Toska^{1

2}, Per-Olof Hansson^{1

2}, Katarina Glise Sandblad^{1

2}, Christian Alex², Lena Bjorck^{1

2}, Ottmar Cronie³, Jonas Bjork^{4

5}, Christina E Lundberg^{1

6}, Martin Adiels³, Annika Rosengren^{1

2}

Affiliations

¹ Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
² Department of Medicine Geriatrics and Emergency Medicine, Sahlgrenska University Hospital, Östra Hospital, Region Västra Götaland, Gothenburg, Sweden.
³ School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
⁴ Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
⁵ Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden.
⁶ Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden.

Abstract

Background: Venous thromboembolism (VTE) (pulmonary embolism (PE) or deep venous thrombosis (DVT)) is common during acute COVID-19. Long-term excess risk has not yet been established.

Objective: To study long-term VTE risk after COVID-19.

Methods: Swedish citizens aged 18-84 years, hospitalized and/or testing positive for COVID-19 between January 1, 2020, and September 11, 2021 (exposed), stratified by initial hospitalization, were compared to matched (1:5) non-exposed population-derived subjects without COVID-19. Outcomes were incident VTE, PE or DVT recorded within 60, 60-<180, and ≥180 days. Cox regression was used for evaluation and a model adjusted for age, sex, comorbidities and socioeconomic markers developed to control for confounders.

Results: Among exposed patients, 48,861 were hospitalized for COVID-19 (mean age 60.6 years) and 894,121 were without hospitalization (mean age 41.4 years). Among patients hospitalized for COVID-19, fully adjusted hazard ratios (HRs) during 60-<180 days were 6.05 (95% confidence interval (CI) 4.80─7.62) for PE and 3.97 (CI 2.96─5.33) for DVT, compared to non-exposed with corresponding estimates among COVID-19 without hospitalization 1.17 (CI 1.01─1.35) and 0.99 (CI 0.86─1.15), based on 475 and 2,311 VTE events, respectively. Long-term (≥180 days) HRs in patients hospitalized for COVID-19 were 2.01 (CI 1.51─2.68) for PE and 1.46 (CI 1.05─2.01) for DVT while non-hospitalized had similar risk to non-exposed, based on 467 and 2,030 VTE events, respectively.

Conclusions: Patients hospitalized for COVID-19 retained an elevated excess risk of VTE, mainly PE, after 180 days, while long-term risk of VTE in individuals with COVID-19 without hospitalization was similar to the non-exposed.

Keywords: COVID-19 / complications; COVID-19 / epidemiology; pulmonary embolism; venous thromboembolism; venous thrombosis.