P149 | Acute and long-term management of venous thromboembolism through the post-COVID-19 pandemic era

M.A. Wu¹, A. Taino¹, P. Facchinetti¹, V. Rossi¹, S. Berra², R. Celano¹, F. Urso¹, A. Meschia¹, R. Colombo³ | ¹Division of Internal Medicine, Luigi Sacco Hospital, University of Milan, ²Department of Biomedical and Clinical Sciences, University of Milan, ³Division of Anesthesiology and Intensive Care, Luigi Sacco Hospital, University of Milan, Italy

Background and Aim: COVID-19 increases the risk of venous thromboembolism (VTE) through a complex interplay of mechanisms collectively termed immunothrombosis. Limited data exist on VTE challenges in the acute setting throughout a dynamic long-term follow-up compared to non-COVID-19 patients. This study aimed to investigate acute and long-term management and complications in VTE patients with and without COVID-19.
Materials and Methods: Prospective, observational, single-center cohort study on VTE patients followed from acute care until 24 months post-diagnosis.
Results: 157 patients, 30 with COVID-19-associated VTE and 127 unrelated to COVID-19, were enrolled. The mean follow-up was 10.8 (±8.9) months. Baseline characteristics were similar, but COVID-19 patients had fewer comorbidities (1.3±1.29 vs. 2.26±1.68, p<0.001) and a lower probability of remaining on anticoagulant therapy after three months (p<0.003). The most used initial therapy was low molecular weight heparin in 130/157 cases, followed by long-term therapy with direct oral anticoagulants in 123/157. Two (6.7%) COVID-19 vs. three (2.4%) non-COVID-19 patients (p=0.243) had major hemorrhagic events. All hemorrhagic events occurred within the first three months. Three non-COVID-19 patients developed chronic thromboembolic pulmonary hypertension. Mortality was 0% in patients with COVID-19 compared to 9.4% in the non-COVID-19 subgroup (p=0.027).
Conclusions: Our study underscores the evolving nature of VTE management, emphasizing the importance of personalized risk-based approaches.