Pulmonary embolism and deep venous thrombosis after COVID-19: long-term risk in a population-based cohort study

Helen Sjöland; Martin Lindgren; Triantafyllia Toska; Per Olof Hansson; Katarina Glise Sandblad; Christian Alex; Lena Björck; Ottmar Cronie; Jonas Björk; Christina E. Lundberg; Martin Adiels; Annika Rosengren

doi:10.1016/j.rpth.2023.100284

Pulmonary embolism and deep venous thrombosis after COVID-19: long-term risk in a population-based cohort study

Helen Sjöland, Martin Lindgren, Triantafyllia Toska, Per Olof Hansson, Katarina Glise Sandblad, Christian Alex, Lena Björck, Ottmar Cronie, Jonas Björk, Christina E. Lundberg, Martin Adiels, Annika Rosengren

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Venous thromboembolism (VTE) (pulmonary embolism [PE] or deep venous thrombosis [DVT]) is common during acute COVID-19. Long-term excess risk has not yet been established. Objectives: To study long-term VTE risk after COVID-19. Methods: Swedish citizens aged 18 to 84 years hospitalized and/or testing positive for COVID-19 between January 1, 2020, and September 11, 2021 (exposed), stratified by initial hospitalization, were compared to matched (1:5), nonexposed, population-derived subjects without COVID-19. Outcomes were incident VTE, PE, or DVT recorded within 60, 60 to <180, and ≥180 days. Cox regression was used for evaluation, and a model adjusted for age, sex, comorbidities, and socioeconomic markers was developed to control for confounders. Results: Among exposed patients, 48,861 were hospitalized for COVID-19 (mean age, 60.6 years) and 894,121 were without hospitalization (mean age, 41.4 years). Among patients hospitalized for COVID-19, fully adjusted hazard ratios during 60 to <180 days were 6.05 (95% CI, 4.80-7.62) for PE and 3.97 (CI, 2.96-5.33) for DVT compared with that for nonexposed patients with corresponding estimates among those with COVID-19 without hospitalization 1.17 (CI, 1.01-1.35) and 0.99 (CI, 0.86-1.15), based on 475 and 2311 VTE events, respectively. Long-term (≥180 days) hazard ratios in patients hospitalized for COVID-19 were 2.01 (CI, 1.51-2.68) for PE and 1.46 (CI, 1.05-2.01) for DVT, while nonhospitalized patients had similar risk as nonexposed patients, based on 467 and 2030 VTE events, respectively. Conclusion: Patients hospitalized for COVID-19 retained an elevated excess risk of VTE, mainly PE, after 180 days, while long-term risk of VTE in individuals with COVID-19 without hospitalization was similar to that in the nonexposed patients.

Original language	English
Article number	100284
Journal	Research and practice in thrombosis and haemostasis
Volume	7
Issue number	5
DOIs	https://doi.org/10.1016/j.rpth.2023.100284
Publication status	Published - 2023

Subject classification (UKÄ)

Cardiology and Cardiovascular Disease

Free keywords

COVID-19/complications
COVID-19/epidemiology
pulmonary embolism
venous thromboembolism
venous thrombosis

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10.1016/j.rpth.2023.100284

PREPARE: Improved preparedness for future pandemics and other health crises through large-scale disease surveillance
Björk, J. (Researcher), Inghammar, M. (Researcher), Litins'ka, Y. (Researcher), Forsell, M. (Researcher), Ohlsson, M. (Researcher), Lingman, M. (Researcher), Wigren Byström, J. (Researcher), Almgren, M. (Researcher), Kahn, F. (Researcher), Rasmussen, M. (Researcher), Malmqvist, U. (Researcher), Mitchell, A. (Researcher), Neumann, A. (Researcher), Dietler, D. (Researcher), Bennet, L. (Researcher), Bonander, C. (Researcher), Eriksson, T. (Researcher), Björkelund, A. (Researcher), Vilhelmsson, A. (Researcher), Nilsson, A. (Researcher), Wetterberg, H. (Researcher), Hassan, M. (Research student) & Hashemi, A. S. (Researcher)
Swedish Research Council
2021/01/01 → 2025/12/31
Project: Research
AIR Lund: AIR Lund - Artificially Intelligent use of Registers
Björk, J. (Researcher), Ohlsson, M. (Researcher), Melander, O. (Researcher), Ekelund, U. (Researcher), Larsson, S. (Researcher), Mattsson, T. (Researcher), Mokhtari, A. (Researcher), de Vries, K. (Researcher), Nilsson, A. (Researcher), Lingman, M. (Researcher), Pashami, S. (Researcher), Ottosson, F. (Researcher), Larsson, A. E. (Administrator), Henriksen, A. (Researcher), Högberg, C. (Research student), Olsson, M. (Research student), Nyström, A. (Research student), Olsson de Capretz, P. (Research student), Björkelund, A. (Researcher), Nilsson, A. (Researcher), Åkesson, A. (Research student), Nordberg, A. (Researcher), Ekström, M. (Researcher), Tolestam Heyman, E. (Research student), Lundager Forberg, J. (Researcher), Berg, J. (Research student), Johansson, A. (Research student), Amirahmadi, A. (Research student), Eriksson, T. (Research student), Khoshnood, A. (Researcher), Mäkinen, M. (Research student), Holmberg, P. (Researcher) & Nilsson, T. N. (Research student)
2018/07/01 → 2025/12/31
Project: Research

Cite this

Sjöland, H., Lindgren, M., Toska, T., Hansson, P. O., Glise Sandblad, K., Alex, C., Björck, L., Cronie, O., Björk, J., Lundberg, C. E., Adiels, M., & Rosengren, A. (2023). Pulmonary embolism and deep venous thrombosis after COVID-19: long-term risk in a population-based cohort study. Research and practice in thrombosis and haemostasis, 7(5), Article 100284. https://doi.org/10.1016/j.rpth.2023.100284

@article{7485828f0b37479c9607ab91709546a6,

title = "Pulmonary embolism and deep venous thrombosis after COVID-19: long-term risk in a population-based cohort study",

abstract = "Background: Venous thromboembolism (VTE) (pulmonary embolism [PE] or deep venous thrombosis [DVT]) is common during acute COVID-19. Long-term excess risk has not yet been established. Objectives: To study long-term VTE risk after COVID-19. Methods: Swedish citizens aged 18 to 84 years hospitalized and/or testing positive for COVID-19 between January 1, 2020, and September 11, 2021 (exposed), stratified by initial hospitalization, were compared to matched (1:5), nonexposed, population-derived subjects without COVID-19. Outcomes were incident VTE, PE, or DVT recorded within 60, 60 to <180, and ≥180 days. Cox regression was used for evaluation, and a model adjusted for age, sex, comorbidities, and socioeconomic markers was developed to control for confounders. Results: Among exposed patients, 48,861 were hospitalized for COVID-19 (mean age, 60.6 years) and 894,121 were without hospitalization (mean age, 41.4 years). Among patients hospitalized for COVID-19, fully adjusted hazard ratios during 60 to <180 days were 6.05 (95% CI, 4.80-7.62) for PE and 3.97 (CI, 2.96-5.33) for DVT compared with that for nonexposed patients with corresponding estimates among those with COVID-19 without hospitalization 1.17 (CI, 1.01-1.35) and 0.99 (CI, 0.86-1.15), based on 475 and 2311 VTE events, respectively. Long-term (≥180 days) hazard ratios in patients hospitalized for COVID-19 were 2.01 (CI, 1.51-2.68) for PE and 1.46 (CI, 1.05-2.01) for DVT, while nonhospitalized patients had similar risk as nonexposed patients, based on 467 and 2030 VTE events, respectively. Conclusion: Patients hospitalized for COVID-19 retained an elevated excess risk of VTE, mainly PE, after 180 days, while long-term risk of VTE in individuals with COVID-19 without hospitalization was similar to that in the nonexposed patients.",

keywords = "COVID-19/complications, COVID-19/epidemiology, pulmonary embolism, venous thromboembolism, venous thrombosis",

author = "Helen Sj{\"o}land and Martin Lindgren and Triantafyllia Toska and Hansson, {Per Olof} and {Glise Sandblad}, Katarina and Christian Alex and Lena Bj{\"o}rck and Ottmar Cronie and Jonas Bj{\"o}rk and Lundberg, {Christina E.} and Martin Adiels and Annika Rosengren",

year = "2023",

doi = "10.1016/j.rpth.2023.100284",

language = "English",

volume = "7",

journal = "Research and practice in thrombosis and haemostasis",

issn = "2475-0379",

publisher = "Wiley",

number = "5",

}

Sjöland, H, Lindgren, M, Toska, T, Hansson, PO, Glise Sandblad, K, Alex, C, Björck, L, Cronie, O, Björk, J, Lundberg, CE, Adiels, M & Rosengren, A 2023, 'Pulmonary embolism and deep venous thrombosis after COVID-19: long-term risk in a population-based cohort study', Research and practice in thrombosis and haemostasis, vol. 7, no. 5, 100284. https://doi.org/10.1016/j.rpth.2023.100284

TY - JOUR

T1 - Pulmonary embolism and deep venous thrombosis after COVID-19

T2 - long-term risk in a population-based cohort study

AU - Sjöland, Helen

AU - Lindgren, Martin

AU - Toska, Triantafyllia

AU - Hansson, Per Olof

AU - Glise Sandblad, Katarina

AU - Alex, Christian

AU - Björck, Lena

AU - Cronie, Ottmar

AU - Björk, Jonas

AU - Lundberg, Christina E.

AU - Adiels, Martin

AU - Rosengren, Annika

PY - 2023

Y1 - 2023

N2 - Background: Venous thromboembolism (VTE) (pulmonary embolism [PE] or deep venous thrombosis [DVT]) is common during acute COVID-19. Long-term excess risk has not yet been established. Objectives: To study long-term VTE risk after COVID-19. Methods: Swedish citizens aged 18 to 84 years hospitalized and/or testing positive for COVID-19 between January 1, 2020, and September 11, 2021 (exposed), stratified by initial hospitalization, were compared to matched (1:5), nonexposed, population-derived subjects without COVID-19. Outcomes were incident VTE, PE, or DVT recorded within 60, 60 to <180, and ≥180 days. Cox regression was used for evaluation, and a model adjusted for age, sex, comorbidities, and socioeconomic markers was developed to control for confounders. Results: Among exposed patients, 48,861 were hospitalized for COVID-19 (mean age, 60.6 years) and 894,121 were without hospitalization (mean age, 41.4 years). Among patients hospitalized for COVID-19, fully adjusted hazard ratios during 60 to <180 days were 6.05 (95% CI, 4.80-7.62) for PE and 3.97 (CI, 2.96-5.33) for DVT compared with that for nonexposed patients with corresponding estimates among those with COVID-19 without hospitalization 1.17 (CI, 1.01-1.35) and 0.99 (CI, 0.86-1.15), based on 475 and 2311 VTE events, respectively. Long-term (≥180 days) hazard ratios in patients hospitalized for COVID-19 were 2.01 (CI, 1.51-2.68) for PE and 1.46 (CI, 1.05-2.01) for DVT, while nonhospitalized patients had similar risk as nonexposed patients, based on 467 and 2030 VTE events, respectively. Conclusion: Patients hospitalized for COVID-19 retained an elevated excess risk of VTE, mainly PE, after 180 days, while long-term risk of VTE in individuals with COVID-19 without hospitalization was similar to that in the nonexposed patients.

AB - Background: Venous thromboembolism (VTE) (pulmonary embolism [PE] or deep venous thrombosis [DVT]) is common during acute COVID-19. Long-term excess risk has not yet been established. Objectives: To study long-term VTE risk after COVID-19. Methods: Swedish citizens aged 18 to 84 years hospitalized and/or testing positive for COVID-19 between January 1, 2020, and September 11, 2021 (exposed), stratified by initial hospitalization, were compared to matched (1:5), nonexposed, population-derived subjects without COVID-19. Outcomes were incident VTE, PE, or DVT recorded within 60, 60 to <180, and ≥180 days. Cox regression was used for evaluation, and a model adjusted for age, sex, comorbidities, and socioeconomic markers was developed to control for confounders. Results: Among exposed patients, 48,861 were hospitalized for COVID-19 (mean age, 60.6 years) and 894,121 were without hospitalization (mean age, 41.4 years). Among patients hospitalized for COVID-19, fully adjusted hazard ratios during 60 to <180 days were 6.05 (95% CI, 4.80-7.62) for PE and 3.97 (CI, 2.96-5.33) for DVT compared with that for nonexposed patients with corresponding estimates among those with COVID-19 without hospitalization 1.17 (CI, 1.01-1.35) and 0.99 (CI, 0.86-1.15), based on 475 and 2311 VTE events, respectively. Long-term (≥180 days) hazard ratios in patients hospitalized for COVID-19 were 2.01 (CI, 1.51-2.68) for PE and 1.46 (CI, 1.05-2.01) for DVT, while nonhospitalized patients had similar risk as nonexposed patients, based on 467 and 2030 VTE events, respectively. Conclusion: Patients hospitalized for COVID-19 retained an elevated excess risk of VTE, mainly PE, after 180 days, while long-term risk of VTE in individuals with COVID-19 without hospitalization was similar to that in the nonexposed patients.

KW - COVID-19/complications

KW - COVID-19/epidemiology

KW - pulmonary embolism

KW - venous thromboembolism

KW - venous thrombosis

U2 - 10.1016/j.rpth.2023.100284

DO - 10.1016/j.rpth.2023.100284

M3 - Article

C2 - 37361398

AN - SCOPUS:85165050954

SN - 2475-0379

VL - 7

JO - Research and practice in thrombosis and haemostasis

JF - Research and practice in thrombosis and haemostasis

IS - 5

M1 - 100284

ER -

Pulmonary embolism and deep venous thrombosis after COVID-19: long-term risk in a population-based cohort study

Abstract

Subject classification (UKÄ)

Free keywords

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PREPARE: Improved preparedness for future pandemics and other health crises through large-scale disease surveillance

AIR Lund: AIR Lund - Artificially Intelligent use of Registers

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