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Rate of Blood Clot and Morbidity after Covid Infection in Northern California

Dr. Kenneth Hughes, Los Angeles plastic surgeon, has been able to avoid any COVID instances in his Los Angeles plastic surgery center since the onset of the pandemic last year. Blood clot is just one of the many complications of acquiring the COVID infection.  It is important to determine the rate of blood clot or VTE as this can lead to pulmonary embolus and massive lung compromise. Nareg H. Roubinian, MD, et al. recently published Incidence of 30-Day Venous Thromboembolism in Adults Tested for SARS-CoV-2 Infection in an Integrated Health Care System in Northern California.  Hospitalization for COVID-19 is associated with high rates of venous thromboembolism (VTE).  Whether SARS-CoV-2 infection affects the risk of VTE outside of the hospital setting remains poorly understood. They reported on the 30-day incidence of outpatient and hospital-associated VTE following SARS-CoV-2 testing among adults.

They reviewed 220, 588 adults who were tested for SARS-CoV-2 by polymerase chain reaction from February 25 through August 31, 2020.  They characterized study participants by demographic information, comorbidities, testing location, and level of care, excluding participants who were asymptomatic at the time of testing or had received anticoagulation in the prior year.

Of the 220 588 patients with symptoms who were tested for SARS-CoV-2 (mean [SD] age, 47.1 [17.3] years; 131 075 [59.4%] women), 26 104 (11.8%) had a positive result. Within 30 days of testing, a VTE was diagnosed in 198 (0.8%) of the patients with a positive SARS-CoV-2 result and 1008 (0.5%) of patients with a negative result. Viral testing took place in an outpatient setting for most of the patients (117 of 198; 59.1%) who had a positive SARS-CoV-2 test result and later developed VTE. Of these 117 patients, 89 (76.1%) required subsequent hospitalization.   The incidence of outpatient VTE among symptomatic patients with positive SARS-CoV-2 test results was similar to that of patients with negative results.  A VTE is a potentially preventable complication of SARS-CoV-2 infection, especially in outpatients with risk factors for thrombosis or severe COVID-19.

Limitations of VTE diagnosis include changes in diagnostic testing patterns because of possible infection transmission or recognition of VTE risk with SARS-CoV-2, as well as increased use of empirical anticoagulation and/or anti-inflammatory agents. These findings suggest that VTE incidence outside of the hospital is not significantly increased with SARS-CoV-2 infection and argue against the routine use of outpatient thromboprophylaxis outside of clinical trials.

The study did not examine rate of pulmonary embolus secondary to VTE.