Patients with COVID-19 are at an increased risk for venous thromboembolism (VTE). With the advent of vaccinations and novel treatments from 2020 through 2022, the landscape of COVID-19 has evolved. Notably, the effects of such interventions on the outcomes of COVID-19-associated VTE have not been thoroughly examined. Data from the RIETE registry were analyzed to evaluate 90-day VTE-related outcomes (all-cause mortality, major bleeding, and VTE recurrences) in patients with COVID-19-associated VTE. We compared the periods before and after the widespread introduction of COVID-19 vaccines: March to December 2020 (pre-vaccine period) and March 2021 to December 2022 (post-vaccine period). Statistical analysis included mixed-effects parametric survival-time models. Among 1,620 patients with COVID-19-associated VTE, most (74.1%) were identified during 2020 period. The analysis revealed a more than two-fold increase in the risk of death within 90 days (adjusted hazard ratio [HR]: 2.27; 95% confidence interval, CI: 1.18-4.38) and major bleeding (adjusted HR: 2.91; 95%CI: 1.08-7.84) for patients from the 2020 period compared to those from the 2021-2022 period. Inpatient subgroup analysis confirmed the observed mortality differences. The frequency of recurrent VTE was low (1.1 vs. 0.7%, respectively), and did not show significant variation between the two periods. Our research provides a comparative perspective on the clinical outcomes of COVID-19-associated VTE before and after the introduction of vaccines. Our findings reveal a significant decrease in the incidence of 90-day mortality and major bleeding in patients with COVID-19-associated VTE in the 2021-2022 period.

Cardiovascular Medicine Division Brigham and Women's Hospital Harvard Medical School Boston MA USA

Center for Outcomes Research and Evaluation Yale New Haven Hospital Yale New Haven CT USA

Chair for the Study of Thromboembolic Disease Faculty of Health Sciences UCAM Universidad Católica San Antonio de Murcia Murcia Spain

CIBER Enfermedades Respiratorias Madrid Spain

Department of Cardiology University Hospital Jean Minjoz Besançon France

Department of Internal Medicine Complejo Hospitalario de Jaén Jaén Spain

Department of Internal Medicine Hospital Clínico San Carlos Madrid Spain

Department of Internal Medicine University Hospital Plzen Plzen Czech Republic

Department of Peripheral Vascular Diseases Rajaie Cardiovascular Medical and Research Center Tehran Iran

Instituto de Investigación Sanitaria Gregorio Marañón Madrid Spain

Internal Medicine Department Hospital General Universitario Gregorio Marañón Madrid Spain

Thrombosis Research Group Brigham and Women's Hospital Harvard Medical School Boston MA USA

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