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Although the incidence of venous thromboembolism (VTE) is high among patients hospitalized with COVID-19, little is known about VTE risk among COVID-19 outpatients. Kaiser Permanente investigators in Northern California retrospectively assessed >220,000 symptomatic outpatients (89%) and inpatients (11%) — 12% of whom tested positive for SARS-CoV-2 infection — to evaluate 30-day incidence of VTE. Average patient age was 47.
Patients positive for COVID-19 had a significantly higher 30-day incidence of VTE than did those who were negative for COVID-19 (4.7 vs. 1.6 cases per 1000 people), including a significant difference among hospitalized patients (5.8 vs. 3.0 cases per 1000 people) but not among outpatients (1.8 vs. 2.2 cases per 1000 people).
Roubinian NH et al. Incidence of 30-day venous thromboembolism in adults tested for SARS-CoV-2 infection in an integrated health care system in northern California. JAMA Intern Med 2021 Apr 5; [e-pub]. (https://doi.org/10.1001/jamainternmed.2021.0488)
Comment
This study suggests that outpatients with COVID-19 do not have excess VTE risk and argues against routine pharmacologic VTE prophylaxis for outpatients with SARS-CoV-2 infections. Whether COVID-19 patients who were hospitalized recently and discharged deserve some duration of postdischarge VTE prophylaxis (as many such patients receive) remains the subject of continued investigation.