Risk of bleeding in pulmonary embolism patients concomitant with COVID-19 undergoing extended anticoagulation: A multicenter cohort study

Yishan Li; Linfeng Xi; Dingyi Wang; Guohui Fan; Xincheng Li; Yiwei Shi; Hong Chen; Chaosheng Deng; Hong Chen; Qin Luo; Zhe Cheng; Shuai Zhang; Zhu Zhang; Yunxia Zhang; Qian Gao; Qiang Huang; Wanmu Xie; Zhenguo Zhai; Chen Wang; CURES investigators

doi:10.1016/j.thromres.2024.109237

Risk of bleeding in pulmonary embolism patients concomitant with COVID-19 undergoing extended anticoagulation: A multicenter cohort study

Thromb Res. 2024 Dec 17:246:109237. doi: 10.1016/j.thromres.2024.109237. Online ahead of print.

Authors

Yishan Li¹, Linfeng Xi², Dingyi Wang³, Guohui Fan³, Xincheng Li⁴, Yiwei Shi⁵, Hong Chen⁶, Chaosheng Deng⁷, Hong Chen⁸, Qin Luo⁹, Zhe Cheng¹⁰, Shuai Zhang¹¹, Zhu Zhang¹¹, Yunxia Zhang¹¹, Qian Gao¹¹, Qiang Huang¹¹, Wanmu Xie¹², Zhenguo Zhai¹³, Chen Wang¹⁴; CURES investigators

Affiliations

¹ The First Clinical Medical College, Shanxi Medical University, Taiyuan, China; National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
² National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Capital Medical University, Beijing, China.
³ National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Data and Project Management Unit, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China.
⁴ National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Harbin Medical University, Harbin, China.
⁵ Department of Pulmonary and Critical Care Medicine, First Hospital of Shanxi Medical University, Taiyuan, China.
⁶ Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
⁷ Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
⁸ Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
⁹ Department of Neurology, The Third Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
¹⁰ Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
¹¹ National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
¹² National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China. Electronic address: [email protected].
¹³ National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China. Electronic address: [email protected].
¹⁴ The First Clinical Medical College, Shanxi Medical University, Taiyuan, China; National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China. Electronic address: [email protected].

PMID: 39719753
DOI: 10.1016/j.thromres.2024.109237

Abstract

Introduction: The impact of Coronavirus disease 2019 (COVID-19) on clinical outcomes in pulmonary embolism (PE) patients receiving extended anticoagulation therapy is not fully understood. The study aimed to investigate the impact of the Omicron outbreak on patients with PE receiving extended anticoagulation therapy.

Materials and methods: This prospective multicenter cohort study was conducted during the Omicron pandemic. Patients diagnosed with PE between January 1, 2016, and September 1, 2022, who were on extended anticoagulation therapy, were recruited. The study compared VTE recurrence and bleeding events between COVID-19 and non-COVID-19 patients, using the propensity score weighting with overlap weights (PSOW) method for the final analysis.

Results: A total of 521 patients with PE receiving extended anticoagulation therapy were enrolled. Patients suffering from COVID-19 had significantly higher bleeding rates (10.5 % vs 2.1 %, p = 0.001), with consistent results after PSOW (OR = 4.79, 95%CI [1.04-22.21], p = 0.045). No significant differences in VTE recurrence were observed between these two groups before and after weighting. During follow-up, 31 % of patients developed long COVID, with higher bleeding rates (14.6 % vs 3.5 %, p < 0.001). After PSOW, there was a significantly increased bleeding risk in patients with long COVID (HR = 3.29, 95%CI [1.28, 8.49]); Log-Rank test p < 0.001). Furthermore, a prior history of active malignancy (OR = 9.3; 95%CI [1.38, 59.98]), chronic kidney disease (OR = 13.98; 95%CI [1.59, 122.27]) and bleeding occurred during the acute phase of COVID-19 (OR = 23.73; 95%CI [5.20, 108.35]) were independent predictors of bleeding in patients with long COVID.

Conclusions: COVID-19 and long COVID are associated with an increased bleeding risk in PE patients undergoing extended anticoagulation therapy. This study emphasizes the need for close monitoring and optimization of anticoagulation strategies in PE patients.

Keywords: Bleeding; COVID-19; Extended anticoagulation; Pulmonary embolism.