Incidence, Predictors, and Outcomes of Venous and Arterial Thrombosis in COVID-19: A Nationwide Inpatient Analysis - 28/06/24

Doi : 10.1016/j.hlc.2024.04.167

Ankit Agrawal, MD ^a,^{^{1
Contributed equally to this work and are to be considered as co-first authors.}}, Suryansh Bajaj, MD ^b,^{^{1
Contributed equally to this work and are to be considered as co-first authors.}}, Umesh Bhagat, MD ^c, Sanya Chandna, MD ^c, Aro Daniela Arockiam, MD ^a, Joseph El Dahdah, MD ^a, Elio Haroun, MD ^a, Rahul Gupta, MD ^d, Shashank Shekhar, MD ^a, Kavin Raj, MD ^e, Divya Nayar, MD ^f, Divyansh Bajaj, MD ^g, Pulkit Chaudhury, MD ^a, Brian P. Griffin, MD ^a, Tom Kai Ming Wang, MBChB, MD ^a,^⁎
^a Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
^b Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
^c Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
^d Lehigh Valley Heart Institute, Lehigh Valley Health Network, Allentown, PA, USA
^e Division of Cardiology, Department of Medicine, University of California Riverside School of Medicine, Riverside, CA, USA
^f Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
^g Department of Pulmonary, Critical Care, and Sleep Medicine, Medical College of Wisconsin, Milwaukee, WI, USA

^∗Corresponding author at: Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus, J1-5, Cleveland Clinic, Cleveland, OH 44195, USADepartment of Cardiovascular MedicineHeartVascular and Thoracic InstituteCleveland Clinic9500 Euclid Avenue, Main Campus, J1-5, Cleveland ClinicClevelandOH44195USA

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Abstract

Background

Coronavirus disease 2019 (COVID-19) is known to increase the risk of venous thromboembolism (VTE) and arterial thromboembolism (ATE). However, the incidence, predictors, and outcomes of clinical thrombosis for inpatients with COVID-19 are not well known. This study aimed to enhance our understanding of clinical thrombosis in COVID-19, its associated factors, and mortality outcomes.

Method

Hospitalised adult (≥18 years of age) patients with COVID-19 in 2020 were retrospectively identified from the US National Inpatient Sample database. Clinical characteristics, incident VTE, ATE, and in-hospital mortality outcomes were recorded. Multivariable logistic regression was performed to identify clinical factors associated with thrombosis and in-hospital mortality in COVID-19 inpatients.

Results

A total of 1,583,135 adult patients with COVID-19 in the year 2020 were identified from the National Inpatient Sample database; patients with thrombosis were 41% females with a mean age of 65.4 (65.1–65.6) years. The incidence of thrombosis was 6.1% (97,185), including VTE at 4.8% (76,125), ATE at 3.0% (47,790), and the in-hospital mortality rate was 13.4% (212,785). Patients with thrombosis were more likely to have respiratory symptoms of COVID-19 (76.7% vs 75%, p<0.001) compared with patients without thrombosis. The main factors associated with overall thrombosis, VTE, and ATE were paralysis, ventilation, solid tumours without metastasis, metastatic cancer, and acute liver failure. Although all thrombosis categories were associated with higher in-hospital mortality for COVID-19 inpatients in univariable analyses (p<0.001), they were not in multivariable analyses—thrombosis (odds ratio [OR] 1.24; 95% confidence interval [CI] 0.90–1.70; p=0.19), VTE (OR 0.70; 95% CI 0.52–1.00; p=0.05), and ATE (OR 1.07; 95% CI 0.92–1.25; p=0.36).

Conclusions

The association of COVID-19 with thrombosis and VTE increases with increasing severity of the COVID-19 disease. Risk stratification of thrombosis is crucial in COVID-19 patients to determine the necessity of thromboprophylaxis.

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Keywords : COVID-19, Venous thrombosis, Arterial thrombosis, Thromboembolism