Surgical patients more likely to develop blood clot after COVID-19, shows study with UAE hospitals

Abu Dhabi: Surgical patients who have recently had COVID-19 are more likely to develop fatal blood clots after surgery, it has been revealed in a new global study that also involved 12 UAE hospitals.

Researchers found that patients diagnosed with previous or ongoing infection with Sars-CoV-2, the virus responsible for COVID-19, are more likely to develop venous thromboembolism (VTE) than those with no history of COVID-19. These blood clots in the veins are the number one preventable cause of death in hospitalised patients.

“The findings of this new global study, in which the GCC region has played a key role, will help us to understand the impact of COVID-19 and arm us in our collective fight against the pandemic,” said Dr Hayder Alsaadi, adjunctive clinical associated professor at Dubai Medical University, and consultant orthopaedic, trauma Surgeon at Rashid Hospital.

“As one of the countries spearheading the global efforts against COVID-19, whether through vaccine distribution or mask production, we are proud to be playing a central part in clinical research. We hope these new findings will strengthen our collective resolve and contribute to the global mission,” Dr Alsaadi said.

GCC contributions

In addition to data from public and private UAE hospitals, the study involved data from 26 hospitals in Saudi Arabia, four in Bahrain, seven in Kuwait, three in Qatar and two in Oman.

VTE was independently associated with 30-day mortality, with five times increased risk of death, within 30 days after surgery in patients who develop VTEs. Patients hospitalised with COVID-19 have previously been shown to have a high risk of VTE — between nine per cent and 26 per cent — despite the use of preventative drugs, and the risk increases to 31 per cent among patients in critical care settings. This study confirms an increased risk in patients hospitalised for surgery also.

Led by experts at the University of Birmingham, surgeons and anaesthetists from around the world worked together as part of the National Institute for Health Research-funded COVIDSurg Collaborative to analyse data from 128,013 patients in 1,630 hospitals across 115 countries. The team published its findings in medical journal, Anaesthesia.

For the purposes of the study, researchers examined data from adult patients, aged 18 and over, undergoing elective or emergency surgery from any speciality.

Recommendations

The research team is now calling on surgeons around the world to be on the lookout for VTE, and to follow routine measures to help prevent clots, such as the sue of appropriate drugs when bleeding risk is minimal, and lowering the threshold for diagnostic testing in patients presenting with signs of VTE.

Routine postoperative care of surgical patients should also include interventions to reduce VTE risk in general, while further research is needed to define the optimal protocols for VTE prevention and treatment for surgical patients with COVID-19 history.

UAE inputs

The 12 UAE hospitals involved in the study were: Mediclinic Alnour Hospital and Sheikh Shakhbout Medical City in Abu Dhabi; Al Jalila Children’s Speciality Hospital, Burjeel Hospital for Advanced Surgery, Dubai Hospital, Latifa Women and Children Hospital, Medcare Orthopaedic and Spine, Mediclinic City Hospital Dubai, Mediclinic Parkview Hospital, Mediclinic, Wellcare Hospital, Neurospinal Hospital and Rashid Hospital in Dubai; and Al-Qassimi Hospital in Sharjah.

“People undergoing surgery are already at higher risk of VTE than the general public, but we discovered that a current or recent [COVID-19] infection was associated with greater risk of postoperative VTE. Most surgical patients have risk factors for VTE, including immobility, surgical wounds and systematic inflammation; the addition of [COVID-19] infection may further increase this risk,” said study co-author Elizabeth Li. Li is a clinical research fellow at the University of Birmingham.

Increased risk

Unlike other patients, surgical patient have undergone an operative procedure that produces an artificial wound. This produced a wound that increases the risk of bleeding, and initiates a series of inflammatory responses known to alter haemodynamics and coagulation.

“The impact of surgery on coagulation and early reports of increased risk of VTE in COVID-19 patients means there is a need to define VTE risk specifically in patients undergoing surgery. This will help clinicians and policymakers around the world construct future systems of identifying and minimising VTE risk in surgical patients with active or prior [COVID-19] infection. Routine postoperative care of surgical patients should include interventions to reduce VTE risk in general, but further research is needed to define the best protocols for VTE prevention and treatment in this setting,” added Aneel Bhangu, co-author from the University of Birmingham.