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Rate of Recurrence After Discontinuing Anticoagulation Therapy in Patients With COVID-19–Associated Venous Thromboembolism

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

There is uncertainty regarding the optimal duration of anticoagulation therapy (AT) after COVID-19–associated venous thromboembolism (VTE). We analyzed the rate of VTE recurrence in patients with COVID-19–associated VTE who discontinued AT.13

This prospective, multinational cohort study used data from the Registro Informatizado de la Enfermedad Tromboembolica (RIETE) registry, which prospectively collects information on patients with VTE.4 Since March 25, 2020, RIETE has incorporated data on COVID-19–associated VTE. This study included patients who developed proximal deep vein thrombosis (DVT) and/or pulmonary embolism (PE) within 30 days of confirmed COVID-19 between March 25, 2020, and April 23, 2021, and discontinued AT after at least 3 months (eMethods in the Supplement).13 Patients with upper limb or unusual sites of DVT, those who did not receive at least 3 months of AT, and those who were followed up for less than 15 days after AT discontinuation were excluded. The observation period for the inception cohort began on the day of AT discontinuation and ended with recurrent VTE, death, or on November 24, 2021. This study was approved by the Ethics Committee of Hospital Germans Trias i Pujol. Oral informed consent was obtained. This study followed the STROBE reporting guideline.

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Article Information

Accepted for Publication: September 12, 2022.

Published Online: November 7, 2022. doi:10.1001/jamainternmed.2022.4954

Corresponding Author: Luis Jara-Palomares, MD, PhD, Medical Surgical Unit of Respiratory Diseases, Hospital Virgen del Rocio. Av. Manuel Siurot s/n, Seville 41013, Spain (luisoneumo@hotmail.com).

Author Contributions: Drs Jara-Palomares, Bikdeli, and Jiménez contributed equally. Dr Jara-Palomares had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Jara-Palomares, Bikdeli, Jimenez, Martin del Pozo, Monreal.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Jara-Palomares, Jimenez, Martin del Pozo.

Critical revision of the manuscript for important intellectual content: Bikdeli, Jimenez, Muriel, Martin del Pozo, Demelo-Rodríguez, Monreal.

Statistical analysis: Jara-Palomares, Jimenez, Muriel.

Obtained funding: Martin del Pozo, Monreal.

Administrative, technical, or material support: Martin del Pozo.

Supervision: Jara-Palomares, Bikdeli, Monreal.

Conflict of Interest Disclosures: Dr Jara-Palomares reported receiving grants from Leo Pharma and MSD and receiving personal fees from Daichii, Rovi, GlaxoSmithKline, and Actellion outside the submitted work. Dr Bikdeli reported being a consulting expert on behalf of the plaintiff for litigation related to 2 brand models of inferior vena cava filters. Dr Jimenez reported receiving personal fees from Pfizer, Bristol Myers Squibb, Daiichi Sankyo, Rovi, and Leo Pharma outside the submitted work. Dr Demelo-Rodríguez reported receiving personal fees from Sanofi, Leo Pharma, Bayer, ROVI, Menarini, and Pfizer outside the submitted work. Dr Monreal reported grants from Sanofi and Rovi outside the submitted work. No other disclosures were reported.

Funding/Support: Dr Bikdeli reported receiving support from the Scott Schoen and Nancy Adams IGNITE Award, and the Mary Ann Tynan Research Scientist award through the Mary Horrigan Connors Center for Women’s Health and Gender Biology, as well as the Heart and Vascular Center Junior Faculty Award, all at Brigham and Women’s Hospital; receiving Career Development Award 928814 from the American Heart Association and VIVA Physicians.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: The Registro Informatizado de la Enfermedad Tromboembolica Registry Coordinating Center, S&H Medical Science Service, provided quality control data and logistic and administrative support. Sanofi Spain, LEO Pharma, and ROVI supported the registry with an unrestricted educational grant.

References
1.
Moores  LK , Tritschler  T , Brosnahan  S ,  et al.  Prevention, diagnosis, and treatment of VTE in patients with coronavirus disease 2019: CHEST Guideline and Expert Panel Report.   Chest. 2020;158(3):1143-1163. doi:10.1016/j.chest.2020.05.559PubMedGoogle ScholarCrossref
2.
Spyropoulos  AC , Levy  JH , Ageno  W ,  et al; Subcommittee on Perioperative, Critical Care Thrombosis, Haemostasis of the Scientific, Standardization Committee of the International Society on Thrombosis and Haemostasis.  Scientific and Standardization Committee communication: clinical guidance on the diagnosis, prevention, and treatment of venous thromboembolism in hospitalized patients with COVID-19.   J Thromb Haemost. 2020;18(8):1859-1865. doi:10.1111/jth.14929PubMedGoogle ScholarCrossref
3.
Stevens  SM , Woller  SC , Baumann Kreuziger  L ,  et al.  Executive summary: antithrombotic therapy for VTE disease: second update of the CHEST Guideline and Expert Panel Report.   Chest. 2021;160(6):2247-2259. doi:10.1016/j.chest.2021.07.056PubMedGoogle ScholarCrossref
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Bikdeli  B , Jimenez  D , Hawkins  M ,  et al; RIETE Investigators.  Rationale, design and methodology of the Computerized Registry of Patients with Venous Thromboembolism (RIETE).   Thromb Haemost. 2018;118(1):214-224. doi:10.1160/TH17-07-0511PubMedGoogle ScholarCrossref
5.
Iorio  A , Kearon  C , Filippucci  E ,  et al.  Risk of recurrence after a first episode of symptomatic venous thromboembolism provoked by a transient risk factor: a systematic review.   Arch Intern Med. 2010;170(19):1710-1716. doi:10.1001/archinternmed.2010.367PubMedGoogle ScholarCrossref
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Delrue  M , Stépanian  A , Voicu  S ,  et al.  No VTE recurrence after 1-year follow up of hospitalized patients with COVID-19 and a VTE event: a prospective study.   Chest. 2022;162(1):p226-p229. doi:10.1016/j.chest.2022.03.043PubMedGoogle ScholarCrossref
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