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Risks of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19: nationwide self-controlled cases series and matched cohort study
The BMJ ( IF 105.7 ) Pub Date : 2022-04-06 , DOI: 10.1136/bmj-2021-069590
Ioannis Katsoularis 1 , Osvaldo Fonseca-Rodríguez 2 , Paddy Farrington 3 , Hanna Jerndal 2 , Erling Häggström Lundevaller 4 , Malin Sund 5, 6 , Krister Lindmark 1 , Anne-Marie Fors Connolly 7
Affiliation  

Objective To quantify the risk of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19. Design Self-controlled case series and matched cohort study. Setting National registries in Sweden. Participants 1 057 174 people who tested positive for SARS-CoV-2 between 1 February 2020 and 25 May 2021 in Sweden, matched on age, sex, and county of residence to 4 076 342 control participants. Main outcomes measures Self-controlled case series and conditional Poisson regression were used to determine the incidence rate ratio and risk ratio with corresponding 95% confidence intervals for a first deep vein thrombosis, pulmonary embolism, or bleeding event. In the self-controlled case series, the incidence rate ratios for first time outcomes after covid-19 were determined using set time intervals and the spline model. The risk ratios for first time and all events were determined during days 1-30 after covid-19 or index date using the matched cohort study, and adjusting for potential confounders (comorbidities, cancer, surgery, long term anticoagulation treatment, previous venous thromboembolism, or previous bleeding event). Results Compared with the control period, incidence rate ratios were significantly increased 70 days after covid-19 for deep vein thrombosis, 110 days for pulmonary embolism, and 60 days for bleeding. In particular, incidence rate ratios for a first pulmonary embolism were 36.17 (95% confidence interval 31.55 to 41.47) during the first week after covid-19 and 46.40 (40.61 to 53.02) during the second week. Incidence rate ratios during days 1-30 after covid-19 were 5.90 (5.12 to 6.80) for deep vein thrombosis, 31.59 (27.99 to 35.63) for pulmonary embolism, and 2.48 (2.30 to 2.68) for bleeding. Similarly, the risk ratios during days 1-30 after covid-19 were 4.98 (4.96 to 5.01) for deep vein thrombosis, 33.05 (32.8 to 33.3) for pulmonary embolism, and 1.88 (1.71 to 2.07) for bleeding, after adjusting for the effect of potential confounders. The rate ratios were highest in patients with critical covid-19 and highest during the first pandemic wave in Sweden compared with the second and third waves. In the same period, the absolute risk among patients with covid-19 was 0.039% (401 events) for deep vein thrombosis, 0.17% (1761 events) for pulmonary embolism, and 0.101% (1002 events) for bleeding. Conclusions The findings of this study suggest that covid-19 is a risk factor for deep vein thrombosis, pulmonary embolism, and bleeding. These results could impact recommendations on diagnostic and prophylactic strategies against venous thromboembolism after covid-19. The study protocol (R script) for the SCCS and matched cohort study are available on request from the corresponding author. The study used secondary registry data, which is regulated by the Public Access to Information and Secrecy Act (2009:400) and is protected by strict confidentiality. However, for the purpose of research, after formal application to access personal data, the responsible authority can grant access to data, although this is contingent on vetting by the Ethical Review Authority of Sweden, according to the Act (2003:460) concerning the Ethical Review of Research Involving Humans. Synthetic (ie, depersonalised and jittered) data can be provided on request from the corresponding author.

中文翻译:

covid-19 后深静脉血栓形成、肺栓塞和出血的风险:全国自控病例系列和匹配队列研究

目的量化covid-19后深静脉血栓形成、肺栓塞和出血的风险。设计自控病例系列和匹配队列研究。在瑞典设置国家登记处。参与者 2020 年 2 月 1 日至 2021 年 5 月 25 日期间在瑞典检测出 SARS-CoV-2 呈阳性的 1 057 174 人在年龄、性别和居住县与 4 076 342 名对照参与者相匹配。主要结果测量 自控病例系列和条件泊松回归用于确定首次深静脉血栓形成、肺栓塞或出血事件的发生率比和风险比以及相应的 95% 置信区间。在自控病例系列中,使用设定的时间间隔和样条模型确定 covid-19 后首次结果的发生率比。第一次和所有事件的风险比是在 covid-19 或索引日期后 1-30 天使用匹配队列研究确定的,并调整了潜在的混杂因素(合并症、癌症、手术、长期抗凝治疗、既往静脉血栓栓塞、或以前的出血事件)。结果与对照组相比,covid-19后70天深静脉血栓、肺栓塞110天、出血60天的发生率显着增加。特别是,在 covid-19 后的第一周,首次肺栓塞的发病率比为 36.17(95% 置信区间为 31.55 至 41.47),第二周为 46.40(40.61 至 53.02)。在 covid-19 后第 1-30 天,深静脉血栓形成的发病率比为 5.90(5.12 至 6.80),31.59(27.99 至 35。63) 用于肺栓塞,2.48 (2.30 至 2.68) 用于出血。同样,covid-19 后第 1-30 天的风险比为:深静脉血栓形成 4.98(4.96 至 5.01),肺栓塞 33.05(32.8 至 33.3),出血风险比 1.88(1.71 至 2.07),经过调整后潜在混杂因素的影响。与第二波和第三波相比,重症 covid-19 患者的发病率最高,在瑞典的第一波大流行期间最高。在同一时期,covid-19 患者中深静脉血栓形成的绝对风险为 0.039%(401 起事件),肺栓塞的绝对风险为 0.17%(1761 起事件),出血的绝对风险为 0.101%(1002 起事件)。结论 本研究结果表明,covid-19 是深静脉血栓形成、肺栓塞和出血的危险因素。这些结果可能会影响对 covid-19 后静脉血栓栓塞的诊断和预防策略的建议。SCCS 和匹配队列研究的研究方案(R 脚本)可向相应作者索取。该研究使用了二级注册数据,该数据受《公共信息获取和保密法》(2009:400) 的监管,并受到严格保密的保护。但是,出于研究目的,在正式申请访问个人数据后,主管当局可以授予对数据的访问权限,尽管这取决于瑞典道德审查机构的审查,根据有关该法案 (2003:460)涉及人类的研究的伦理审查。可根据通讯作者的要求提供合成(即去个性化和抖动)数据。
更新日期:2022-04-06
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