Registry of Arterial and Venous Thromboembolic Complications in Patients With COVID-19

Cardiovascular complications, including myocardial infarction, ischemic stroke, and pulmonary embolism, represent an important source of adverse outcomes in coronavirus disease-2019 (COVID-19). To assess the frequency of arterial and venous thromboembolic disease, risk factors, prevention and manage...

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Published in:Journal of the American College of Cardiology Vol. 76; no. 18; p. 2060
Main Authors: Piazza, Gregory, Campia, Umberto, Hurwitz, Shelley, Snyder, Julia E, Rizzo, Samantha M, Pfeferman, Mariana B, Morrison, Ruth B, Leiva, Orly, Fanikos, John, Nauffal, Victor, Almarzooq, Zaid, Goldhaber, Samuel Z
Format: Journal Article
Language:English
Published: United States 03.11.2020
Subjects:
Adult
Aged
Anticoagulants - therapeutic use
Betacoronavirus
Coronavirus Infections - complications
Coronavirus Infections - mortality
COVID-19
Female
Humans
Intensive Care Units - statistics & numerical data
Male
Massachusetts - epidemiology
Middle Aged
Pandemics
Pneumonia, Viral - complications
Pneumonia, Viral - mortality
Registries
Retrospective Studies
Risk Factors
SARS-CoV-2
Thromboembolism - epidemiology
Thromboembolism - prevention & control
Thromboembolism - virology
Massachusetts
COVID-19
cardiovascular disease
thromboembolism
anticoagulation
myocardial infarction
coronavirus
deep venous thrombosis
pulmonary embolism
stroke
ISSN:1558-3597, 1558-3597
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Summary:Cardiovascular complications, including myocardial infarction, ischemic stroke, and pulmonary embolism, represent an important source of adverse outcomes in coronavirus disease-2019 (COVID-19). To assess the frequency of arterial and venous thromboembolic disease, risk factors, prevention and management patterns, and outcomes in patients with COVID-19, the authors designed a multicenter, observational cohort study. We analyzed a retrospective cohort of 1,114 patients with COVID-19 diagnosed through our Mass General Brigham integrated health network. The total cohort was analyzed by site of care: intensive care (n = 170); hospitalized nonintensive care (n = 229); and outpatient (n = 715). The primary study outcome was a composite of adjudicated major arterial or venous thromboembolism. Patients with COVID-19 were 22.3% Hispanic/Latinx and 44.2% non-White. Cardiovascular risk factors of hypertension (35.8%), hyperlipidemia (28.6%), and diabetes (18.0%) were common. Prophylactic anticoagulation was prescribed in 89.4% of patients with COVID-19 in the intensive care cohort and 84.7% of those in the hospitalized nonintensive care setting. Frequencies of major arterial or venous thromboembolism, major cardiovascular adverse events, and symptomatic venous thromboembolism were highest in the intensive care cohort (35.3%, 45.9%, and 27.0 %, respectively) followed by the hospitalized nonintensive care cohort (2.6%, 6.1%, and 2.2%, respectively) and the outpatient cohort (0% for all). Major arterial or venous thromboembolism, major adverse cardiovascular events, and symptomatic venous thromboembolism occurred with high frequency in patients with COVID-19, especially in the intensive care setting, despite a high utilization rate of thromboprophylaxis.
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ISSN:1558-3597
1558-3597
DOI:10.1016/j.jacc.2020.08.070