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Thromb Haemost 2023; 123(11): 1089-1099
DOI: 10.1055/a-2087-3003
Atherosclerosis and Ischaemic Disease

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

Dimitrios Giannis
1   Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
2   Department of Vascular Surgery, University of Thessaly, Larissa, Greece
3   Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, New York, New York, United States
4   Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
,
Mark Goldin
1   Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
3   Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, New York, New York, United States
4   Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
,
Husneara Rahman
1   Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
4   Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
,
Cristina P. Sison
1   Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
4   Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
,
Martin L. Lesser
1   Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
4   Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
,
Sam Ngu
1   Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
3   Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, New York, New York, United States
4   Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
,
James Tsang
1   Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
4   Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
,
Michael Qiu
1   Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
4   Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
,
Shreya Sanghani
1   Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
4   Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
,
Jackson Yeh
1   Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
4   Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
,
Miltiadis Matsagkas
2   Department of Vascular Surgery, University of Thessaly, Larissa, Greece
5   Department of Anesthesiology, University of Thessaly, Larissa, Greece
,
Eleni Arnaoutoglou
2   Department of Vascular Surgery, University of Thessaly, Larissa, Greece
5   Department of Anesthesiology, University of Thessaly, Larissa, Greece
,
Alex C. Spyropoulos 
1   Institute of Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
3   Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, New York, New York, United States
4   Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
› Author Affiliations Funding The CORE-19 registry was funded in part by the Broxmeyer Fellowship in Clinical Thrombosis, Janssen Pharmaceuticals, and a scholarship provided by the Hellenic Medical Society of New York (HMSNY). This work was also supported by grant R24AG064191 from the National Institute on Aging of the National Institutes of Health. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. The views expressed in this article are those of the authors and do not represent the views of the National Institutes of Health, the United States Department of Health and Human Services, or any other government entity.
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Abstract

Background Coronavirus disease 2019 (COVID-19) is associated with venous and arterial thromboembolism (VTE and ATE) and all-cause mortality (ACM) in hospitalized patients. High-quality data are needed on postdischarge outcomes in patients with cardiovascular disease.

Objectives To analyze outcomes and identify risk factors for ATE, VTE, and ACM in a high-risk subgroup of hospitalized COVID-19 patients with baseline cardiovascular disease.

Methods We investigated postdischarge rates and associated risk factors of ATE, VTE, and ACM in 608 hospitalized COVID-19 patients with coronary artery disease, carotid artery stenosis (CAS), peripheral arterial disease (PAD), or ischemic stroke.

Results Through 90 days postdischarge, outcome rates were: ATE 27.3% (10.2% myocardial infarction, 10.1% ischemic stroke, 13.2% systemic embolism, 12.7% major adverse limb event); VTE 6.9% (4.1% deep vein thrombosis, 3.6% pulmonary embolism); composite of ATE, VTE, or ACM 35.2% (214/608). Multivariate analysis showed significant association between this composite endpoint and age >75 years (odds ratio [OR]: 1.90, 95% confidence interval [CI]: 1.22–2.94, p = 0.004), PAD (OR: 3.23, 95% CI: 1.80–5.81, p ≤ 0.0001), CAS (OR: 1.74, 95% CI: 1.11–2.75, p = 0.017), congestive heart failure (CHF) (OR: 1.84, 95% CI: 1.02–3.35, p = 0.044), previous VTE (OR: 3.08, 95% CI: 1.75–5.42, p < 0.0001), and intensive care unit (ICU) admission (OR: 2.93, 95% CI: 1.81–4.75, p < 0.0001).

Conclusion COVID-19 inpatients with cardiovascular disease experience high rates of ATE, VTE, or ACM through 90 days postdischarge. Age >75 years, PAD, CAS, CHF, previous VTE, and ICU admission are independent risk factors.

Keywords

COVID-19 - arterial thromboembolism - venous thromboembolism - anticoagulation - postdischarge outcomes

Note

“High rates and risk factors of #ATE, #VTE, and all-cause mortality through three months post-discharge in a high risk #COVID-19 population with cardiovascular comorbidities: Insights from the CORE-19 registry.”


Authors' Contribution

D.G. and A.C.S. conceived and designed the study; D.G., M.G., H.R., C.P.S., M.L.L., S.N., J.T., M.Q., S.S., J.Y., M.M., E.A., and A.C.S. acquired, analyzed, or interpreted data; H.R.,C.P.S, M.L.L, J.T., M.Q., S.S., and J.Y. performed statistical analysis; A.C.S., M.M., J.Y., and E.A. supervised the study; D.G., A.C.S., and M.G. drafted the manuscript; D.G., H.R., C.P.S, M.L.L, J.T., M.Q., S.S., and J.Y. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis; and all authors approved the final version of the manuscript.


Supplementary Material



Publication History

Received: 17 March 2023

Accepted: 03 May 2023

Accepted Manuscript online:
05 May 2023

Article published online:
01 June 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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