Occurrence of Thromboembolic Events and Mortality Among Hospitalized Coronavirus 2019 Patients: Large Observational Cohort Study of Electronic Health Records

Abstract

Background: Most symptoms of COVID-19 are mild; however, some patients experience cardiovascular complications, including thromboembolic events and death. Data are needed to better inform prevention and treatment of these events. This analysis was designed to describe patient characteristics, medication use, thromboembolic events, and all-cause mortality in hospitalized COVID-19 patients in the United States. Methods: This retrospective, observational cohort study identified adults hospitalized with COVID-19 (01/21/2020-01/07/2021) in the de-identified Optum® COVID-19 Electronic Health Records dataset. Thromboembolic events and all-cause mortality were collected at any time during the variable follow-up period (up to 50 weeks). Results: Of 181,995 COVID-19 patients who met eligibility criteria, 40,524 (22.3%) were hospitalized with COVID-19. Hospitalized patients had a mean age of 63 years and a Quan-Charlson comorbidity index of 1.3. Anticoagulants were used in 89.2% of patients during hospitalization and in 18.7% of post-discharge patients. Of hospitalized patients, 17.6% had a thromboembolic event during the entire follow-up period (mean time to first event of 15 days), of whom 13.4% had an event during hospitalization; of discharged patients, 4.3% had a thromboembolic event (mean time from discharge to event of 43 days). Death during the follow-up period was reported in 15.0% of patients. Conclusions: In this large, observational cohort study, patients hospitalized with COVID-19 had high rates of thromboembolic events during hospitalization and in the post-discharge period; mortality was also high in this population. Anticoagulant use was common during hospitalization. These findings support further study to optimize in-hospital and extended prophylaxis for hospitalized COVID-19 patients.

Risk Factors for Postdischarge Major Thromboembolism and Mortality in Hospitalized Patients with COVID-19 with Cardiovascular Comorbidities: Insights from the CORE-19 Registry

“…18 Early prospective data from the US placed the ATE rate at 1.71% in the 3-month post-discharge period, while a recently published retrospective observational study of 40,524 hospitalized patients with COVID-19 reported post-discharge rates of ischemic stroke, myocardial infarction, and acute limb ischemia of 1.18%, 1.53%, and 0.10%, respectively, at a mean follow-up of 70.7 days. 16,19 Further, in a recent meta-analysis of 7,816 discharged patients with COVID-19, ATE This article is protected by copyright. All rights reserved.…”

“…16 Subsequently, a recently published retrospective observational study of 40,524 hospitalized patients with COVID-19 reported post-discharge rates of ischemic stroke, myocardial infarction, and acute limb ischemia of 1.18%, 1.53%, and 0.10%, respectively at a mean follow-up of 70.7 days and time to first-event 71.6, 52.6, and 83.5 days, respectively. 19 Data from a recent meta-analysis of 7,816 discharged patients with COVID-19 showed an ATE rate of 1.46% for a post-discharge follow-up period of up to 6 months among the included studies, while another large metaanalysis of 20,875,843 patients in the post-acute phase of COVID-19 showed a cumulative postdischarge rate of incident MI between 0.1 to 1.1% with a mean follow-up of 8.5 months. 20,30 Lastly, the REMAP-CAP trial in hospitalized severe COVID-19 patients showed a benefit on 90day mortality, at the cost of a significantly increased risk of major bleeding in patients receiving antiplatelets (OR = 2.97; 95% CI, 1.23-8.28).…”

“…18 Early prospective data from the United States placed the ATE rate at 1.71% in the 3-month postdischarge period, while a recently published retrospective observational study of 40,524 hospitalized patients with COVID-19 reported postdischarge rates of ischemic stroke, MI, and acute limb ischemia of 1.18, 1.53, and 0.10%, respectively, at a mean follow-up of 70.7 days. 16,19 Further, in a recent meta-analysis of 7,816 discharged patients with COVID-19, ATE was estimated at 1.46% at a postdischarge follow-up period up to 6 months among the included studies. 20 Rates of postdischarge VTE may be at least fourfold greater in COVID-19 patients compared with prepandemic populations and range from 0.2 to 14.8%, with a recent meta-analysis showing a pooled incidence of 1.8% (DVT and PE incidence of 0.9 and 1.5%, respectively) at a mean follow-up of 61.7 days and VTE occurring at an average of 2 weeks postdischarge.…”

“…Coronavirus disease 2019 (COVID- 19) is strongly associated with macrovascular thromboembolic events, including venous thromboembolism (VTE), such as deep vein thrombosis (DVT) and pulmonary embolism (PE), as well as arterial thromboembolism (ATE), such as ischemic stroke and myocardial infarction (MI), particularly in hospitalized patients with severe or critical illness. [1][2][3][4] Thromboinflammation and immunothrombosis have been proposed as core mechanisms of COVID-19 pathogenesis and involve overt inflammation, activation of coagulation pathways, and inflammatory cytokine release resulting in microvascular thrombosis, thrombotic microangiopathy, and multi-organ damage.…”

A Happy New Year 2023 from Thrombosis and Haemostasis

“…Another nice example of a visual summary from TH Open is the paper by Spyropoulos et al 18 These also facilitate our social media activities, which include interviews with authors of featured papers, for example, this one by Kim et al 19 https://twitter.com/TH_Journal/status/15572940705061 80608.…”