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

, COVIDSurg Collaborative and , GlobalSurg Collaborative (2022) SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study. Anaesthesia, 77 (1). pp. 28-39. ISSN 0003-2409

[img]
Preview
PDF (Anaesthesia_2021) - Published Version
Available under License Creative Commons Attribution.

Download (605kB) | Preview

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.

Item Type: Article
Additional Information: 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.
Uncontrolled Keywords: covid-19,sars-cov-2,deep vein thrombosis,pulmonary embolism,venous thromboembolism,anesthesiology and pain medicine ,/dk/atira/pure/subjectarea/asjc/2700/2703
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Related URLs:
Depositing User: LivePure Connector
Date Deposited: 04 Jan 2022 09:30
Last Modified: 09 Jan 2022 01:16
URI: https://ueaeprints.uea.ac.uk/id/eprint/82847
DOI: 10.1111/anae.15563

Actions (login required)

View Item View Item