Postdischarge thromboembolic outcomes and mortality of hospitalized patients with COVID-19: the CORE-19 registry.
Dimitrios GiannisSteven L AllenJames TsangSarah FlintTamir PinhasovStephanie WilliamsGary TanRicha ThakurChristian LeungMatthew SnyderChirag BhatiaDavid GarrettChristina CotteShelby IsaacsEmma GugertyAnne DavidsonGalina S MarderAustin SchnitzerBradley GoldbergThomas McGinnKarina W DavidsonMatthew A BarishMichael QiuMeng ZhangMark GoldinMiltiadis MatsagkasEleni ArnaoutoglouAlex C SpyropoulosPublished in: Blood (2021)
Thromboembolic events, including venous thromboembolism (VTE) and arterial thromboembolism (ATE), and mortality from subclinical thrombotic events occur frequently in coronavirus disease 2019 (COVID-19) inpatients. Whether the risk extends postdischarge has been controversial. Our prospective registry included consecutive patients with COVID-19 hospitalized within our multihospital system from 1 March to 31 May 2020. We captured demographics, comorbidities, laboratory parameters, medications, postdischarge thromboprophylaxis, and 90-day outcomes. Data from electronic health records, health informatics exchange, radiology database, and telephonic follow-up were merged. Primary outcome was a composite of adjudicated VTE, ATE, and all-cause mortality (ACM). Principal safety outcome was major bleeding (MB). Among 4906 patients (53.7% male), mean age was 61.7 years. Comorbidities included hypertension (38.6%), diabetes (25.1%), obesity (18.9%), and cancer history (13.1%). Postdischarge thromboprophylaxis was prescribed in 13.2%. VTE rate was 1.55%; ATE, 1.71%; ΑCM, 4.83%; and MB, 1.73%. Composite primary outcome rate was 7.13% and significantly associated with advanced age (odds ratio [OR], 3.66; 95% CI, 2.84-4.71), prior VTE (OR, 2.99; 95% CI, 2.00-4.47), intensive care unit (ICU) stay (OR, 2.22; 95% CI, 1.78-2.93), chronic kidney disease (CKD; OR, 2.10; 95% CI, 1.47-3.0), peripheral arterial disease (OR, 2.04; 95% CI, 1.10-3.80), carotid occlusive disease (OR, 2.02; 95% CI, 1.30-3.14), IMPROVE-DD VTE score ≥4 (OR, 1.51; 95% CI, 1.06-2.14), and coronary artery disease (OR, 1.50; 95% CI, 1.04-2.17). Postdischarge anticoagulation was significantly associated with reduction in primary outcome (OR, 0.54; 95% CI, 0.47-0.81). Postdischarge VTE, ATE, and ACM occurred frequently after COVID-19 hospitalization. Advanced age, cardiovascular risk factors, CKD, IMPROVE-DD VTE score ≥4, and ICU stay increased risk. Postdischarge anticoagulation reduced risk by 46%.
Keyphrases
- venous thromboembolism
- coronavirus disease
- direct oral anticoagulants
- chronic kidney disease
- intensive care unit
- electronic health record
- cardiovascular risk factors
- coronary artery disease
- sars cov
- atrial fibrillation
- type diabetes
- end stage renal disease
- cardiovascular disease
- metabolic syndrome
- public health
- cardiovascular events
- insulin resistance
- respiratory syndrome coronavirus
- risk factors
- big data
- squamous cell carcinoma
- climate change
- risk assessment
- skeletal muscle
- young adults
- acute coronary syndrome
- data analysis
- transcatheter aortic valve replacement
- clinical decision support