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

• Published in: Journal of the American College of Cardiology Vol. 76; no. 18; pp. 2060 - 2072
• 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 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation 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; Original Investigation; 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: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2020.08.070

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.