Venous Thromboembolism and Major Bleeding in Patients With Coronavirus Disease 2019 (COVID-19): A nationwide population-based cohort study

Michael Dalager-Pedersen, Lars Christian Lund, Theis Mariager, Rannva Winther, Maja Hellfritzsch Poulsen, Torben Bjerregaard Larsen, Reimar Wernich Thomsen, Nanna Borup Johansen, Ole Schmeltz Søgaard, Stig Lønberg Nielsen, Lars Haukali Hvass Omland, Lene Fogt Lundbo, Simone Bastrup Israelsen, Zitta Barrella Harboe, A Pottegård, Henrik Nielsen, Jacob Bodilsen*

*Corresponding author for this work

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BACKGROUND: Venous thromboembolism (VTE) is a potentially fatal complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and thromboprophylaxis should be balanced against risk of bleeding. This study examined risks of VTE and major bleeding in hospitalized and community-managed SARS-CoV-2 patients compared with control populations. METHODS: Using nationwide population-based registries, 30-day risks of VTE and major bleeding in SARS-CoV-2 positive patients were compared with those of SARS-CoV-2 test-negative patients and with an external cohort of influenza patients. Medical records of all COVID-19 patients at 6 departments of infectious diseases in Denmark were reviewed in detail. RESULTS: The overall 30-day risk of VTE was 0.4% (40/9460) among SARS-CoV-2 patients (16% hospitalized), 0.3% (649/226 510) among SARS-CoV-2 negative subjects (12% hospitalized), and 1.0% (158/16 281) among influenza patients (59% hospitalized). VTE risks were higher and comparable in hospitalized SARS-CoV-2 positive (1.5%), SARS-CoV-2 negative (1.8%), and influenza patients (1.5%). Diagnosis of major bleeding was registered in 0.5% (47/9460) of all SARS-CoV-2 positive individuals and in 2.3% of those hospitalized. Medical record review of 582 hospitalized SARS-CoV-2 patients observed VTE in 4% (19/450) and major bleeding in 0.4% (2/450) of ward patients, of whom 31% received thromboprophylaxis. Among intensive care patients (100% received thromboprophylaxis), risks were 7% (9/132) for VTE and 11% (15/132) for major bleeding. CONCLUSIONS: Among people with SARS-CoV-2 infection in a population-based setting, VTE risks were low to moderate and were not substantially increased compared with SARS-CoV-2 test-negative and influenza patients. Risk of severe bleeding was low for ward patients, but mirrored VTE risk in the intensive care setting.

Original languageEnglish
JournalClinical Infectious Diseases
Issue number12
Pages (from-to)2283-2293
Publication statusPublished - 16. Dec 2021


  • Anticoagulants
  • COVID-19
  • Cohort Studies
  • Hemorrhage/epidemiology
  • Humans
  • SARS-CoV-2
  • Venous Thromboembolism/epidemiology
  • bleeding
  • venous thromboembolism
  • deep venous thrombosis
  • pulmonary embolism
  • hemorrhage


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