Key result
ICU-level COVID-19 is linked to a ~35% rate of major thromboembolism versus non-ICU hospitalization.
Why the study?
Cardiovascular complications including arterial and venous thromboembolism are important adverse outcomes in COVID-19, but their frequency, risk factors, prevention, and management patterns require assessment.
Cohort (n=1,114)
Yes
Absolute Event Rate: 35.3% vs 2.6%
Patients with COVID-19, particularly those requiring intensive care, experience a high rate of major arterial and venous thromboembolic complications despite high utilization of prophylactic anticoagulation.
Caution advised against assuming standard thromboprophylaxis protects ICU COVID-19 patients; leaves open benefit of intensified dosing in randomized trials.
BACKGROUND: Cardiovascular complications, including myocardial infarction, ischemic stroke, and pulmonary embolism, represent an important source of adverse outcomes in coronavirus disease-2019 (COVID-19). OBJECTIVES: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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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Piazza et al. (2020) conducted a cohort in COVID-19 (n=1,114). Intensive care vs. Hospitalized nonintensive care was evaluated on composite of adjudicated major arterial or venous thromboembolism. Major arterial or venous thromboembolism occurred in 35.3% of COVID-19 patients in intensive care, compared to 2.6% in hospitalized nonintensive care and 0% in outpatients.
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