COVID-19 is associated with higher risk of venous thrombosis, but not arterial thrombosis, compared with influenza: Insights from a large US cohort

Abstract

Introduction Infection with SARS-CoV-2 is typically compared with influenza to contextualize its health risks. SARS-CoV-2 has been linked with coagulation disturbances including arterial thrombosis, leading to considerable interest in antithrombotic therapy for Coronavirus Disease 2019 (COVID-19). However, the independent thromboembolic risk of SARS-CoV-2 infection compared with influenza remains incompletely understood. We evaluated the adjusted risks of thromboembolic events after a diagnosis of COVID-19 compared with influenza in a large retrospective cohort. Methods We used a US-based electronic health record (EHR) dataset linked with insurance claims to identify adults diagnosed with COVID-19 between April 1, 2020 and October 31, 2020. We identified influenza patients diagnosed between October 1, 2018 and April 31, 2019. Primary outcomes [venous composite of pulmonary embolism (PE) and acute deep vein thrombosis (DVT); arterial composite of ischemic stroke and myocardial infarction (MI)] and secondary outcomes were assessed 90 days post-diagnosis. Propensity scores (PS) were calculated using demographic, clinical, and medication variables. PS-adjusted hazard ratios (HRs) were calculated using Cox proportional hazards regression. Results There were 417,975 COVID-19 patients (median age 57y, 61% women), and 345,934 influenza patients (median age 47y, 66% women). Compared with influenza, patients with COVID-19 had higher venous thromboembolic risk (HR 1.53, 95% CI 1.38–1.70), but not arterial thromboembolic risk (HR 1.02, 95% CI 0.95–1.10). Secondary analyses demonstrated similar risk for ischemic stroke (HR 1.11, 95% CI 0.98–1.25) and MI (HR 0.93, 95% CI 0.85–1.03) and higher risk for DVT (HR 1.36, 95% CI 1.19–1.56) and PE (HR 1.82, 95% CI 1.57–2.10) in patients with COVID-19. Conclusion In a large retrospective US cohort, COVID-19 was independently associated with higher 90-day risk for venous thrombosis, but not arterial thrombosis, as compared with influenza. These findings may inform crucial knowledge gaps regarding the specific thromboembolic risks of COVID-19.

Impact of COVID-19 on Patients Hospitalized With Deep Vein Thrombosis and/or Pulmonary Embolism: A Nationwide Analysis

“…A cohort study from the US showed that COVID-19 was independently associated with a higher 90-day risk for venous thrombosis but not arterial thrombosis, compared with influenza. 11 Another study from Europe showed patients with influenza were more often diagnosed with arterial thrombotic complications than patients with COVID-19 infection. 12 Our analysis found that in-hospital stroke was higher in flu patients compared to COVID-19 patients.…”

SARS‐CoV‐2 infection and multi-organ system damage: a review

“…The illness can result in venous and arterial thrombosis, especially pulmonary embolism (PE) and microthrombi. A recent study on 417,975 COVID-19 and 345,934 influenza patients revealed that COVID-19 patients had higher venous thrombosis risk than influenza patients, but not arterial thrombosis [ 37 ]. The arterial thrombosis occurs in approximately 4% of critically ill COVID-19 patients—particularly in male, elder, and comorbid ones.…”

Incidence, risk factors, and clinical impact of major bleeding in hospitalized patients with COVID-19: a sub-analysis of the CLOT-COVID Study

“…Notably, the incidence of major bleeding is not significantly higher in COVID-19 than in other critical illnesses [ 3 , 27 ]. This is intriguing because thrombotic events, especially pulmonary thromboembolism, have a higher incidence rate among patients with COVID-19 than in those with other acute illnesses [ 28 ]. This could be attributed to a COVID-19-specific coagulopathy characterized by in-situ formation of immune-thrombosis in the lungs [ 1 ].…”