Arterial Thrombotic Events in Adult Inpatients With COVID-19

Abstract

Objective: To evaluate the clinical course of and risk factors for arterial thrombotic events in adult inpatients with coronavirus disease 2019 . Methods: All consecutive adult patients admitted for COVID-19 infection in a referral center in France and discharged from the hospital between April 1 and April 30, 2020, were included. All arterial thrombotic events that occurred through discharge were considered for analysis. Epidemiologic, demographic, clinical, laboratory, treatment, and outcome data were extracted from electronic medical records with use of a standardized data collection form. Results: Overall, 531 COVID-19þ patients were analyzed. Among them, 30 (5.6%) experienced arterial thrombotic events. Arterial thrombotic events in the setting of COVID-19 infection happened at a median of 11 (5-20) days after the first symptoms of infection; occurred in high-risk patients according to traditional cardiovascular risk factors; had an atypical pattern, such as thrombosis of the aorta, upper limb, or renal arteries or cerebral microvasculopathy in 7 (23.3%) cases; and were associated with an in-hospital mortality rate of 40%. Arterial thrombotic events increased the risk of death by 3-fold in COVID-19þ patients (hazard ratio, 2.96; 95% CI, 1.4 to 4.7; P¼.002). A subdistribution survival hazard model showed that a concentration of D-dimer above 1250 ng/mL increased the risk of arterial thrombotic events in COVID-19þ patients by more than 7 (subdistribution hazard ratio, 7.68; 95% CI, 2.9 to 20.6; P<.001). Conclusion:A dramatically high rate of in-hospital death was observed in patients who suffered arterial thrombotic events in the setting of COVID-19 infection. A D-dimer level above 1250 ng/mL at entry may identify COVID-19þ patients at risk for arterial thrombotic events.

Incidence of thrombotic complications in COVID-19

“…In one large retrospective observational study of 3556 patients, 32 (0.9%) developed an ischaemic stroke, 4 occurring without any symptoms of COVID-19 prior to the event, and in the remainder of cases, stroke developed up to 27 days following COVID-19 symptom onset [14]. Two further reports of COVID-19 in hospital have identified an incidence of arterial thrombosis in 1.8% of 2021 patients, and 5.6% of 531 patients [15,16].…”

Acute limb ischemia in COVID-19 patients: an overview

“…24 Although ALI is a complication of COVID-19 in hospitalized patients, it is now being understood that it can arise in patients with mild COVID-19 symptoms, and that ALI can be the first presenting sign of COVID-19 even in the absence of respiratory symptoms. 27 In a study of 49 patients diagnosed with COVID-19, 22 (45%) showed symptoms of acute arterial ischemia before being diagnosed with COVID-19, while the remaining 27 (55%) experienced ischemia during hospitalization. 28 Infected patients with little to no COVID-19 symptoms can experience a prothrombotic state, and some studies have identified patients who complained mostly of acute extremity discomfort, which was mostly accompanied by moderate respiratory symptoms or other COVID-19 symptoms, although in some instances, ALI was the only clinical manifestation of COVID-19.…”

Unusual Presentation of a Severe COVID-19 Case With Axillary Artery Thrombosis

“…Another mechanism is the inflammatory storm through secretion of mediators, such as interleukin-6 (IL-6), and production of C-reactive protein (CRP), fibrinogen, ferritin, and D-dimer, which triggers the complement cascade, thus inducing a hypercoagulable state [ 7 ]. All these mechanisms have been linked to the degree of COVID-19 severity [ 17 ]. Additionally, autoantibodies, such as antiphospholipid and anticardiolipin, have been described in sporadic cases of COVID-19; another theory to explain hypercoagulability is related to the neutrophil extracellular traps that are formed to contain the virus within vessels, which have been associated with triggering of the intrinsic coagulation pathway [ 18 ].…”