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Macrovascular Thrombotic Events in a Mayo Clinic Enterprise-Wide Sample of Hospitalized COVID-19-Positive Compared
Rahul Chaudhary1, Leslie Padrnos2, Ewa Wysokinska3
1Division of Hospital Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Division of Cardiology, University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, PA.
Insights
Hospitalized patients with coronavirus disease 2019 (COVID-19) did not have a higher rate of thromboembolic complications compared to COVID-19-negative patients. This study found a lower than previously reported incidence of thrombotic events in COVID-19 patients.
Area of Science:
- Medical Research
- Infectious Diseases
- Cardiology
Background:
- The incidence of thromboembolic complications in patients with coronavirus disease 2019 (COVID-19) has been a significant concern.
- Previous reports suggested a higher risk of thrombotic events in COVID-19 patients.
Purpose of the Study:
- To compare the rate of thromboembolic complications between hospitalized patients who tested positive for COVID-19 and those who tested negative.
- To determine if COVID-19 infection increases the risk of venous and arterial thrombotic events.
Main Methods:
- Retrospective analysis of adult patients hospitalized between January 1, 2020, and May 8, 2020.
- Identification of COVID-19 status via polymerase chain reaction assay.
- Extraction of thrombotic outcomes from electronic health records across multiple hospitals.
Main Results:
- A total of 3790 patients were analyzed, with 102 testing positive for COVID-19.
- The incidence of any venous thromboembolism was 2.9% in COVID-19 positive patients and 4.6% in COVID-19 negative patients.
- No significant difference in the frequency of venous or arterial thrombotic events was observed between the two groups.
Conclusions:
- The early experience suggests a lower incidence of thrombotic events in hospitalized COVID-19 patients than previously reported.
- The risk of thromboembolic complications in COVID-19 patients was not higher than in a contemporary cohort of hospitalized COVID-19-negative patients.
Objective:
To determine the difference in the rate of thromboembolic complications between hospitalized coronavirus disease 2019 (COVID-19)-positive compared with COVID-19-negative patients.
Patients And Methods:
Adult patients hospitalized from January 1, 2020, through May 8, 2020, who had COVID-19 testing by polymerase chain reaction assay were identified through electronic health records across multiple hospitals in the Mayo Clinic enterprise. Thrombotic outcomes (venous and arterial) were identified from the hospital problem list.
Results:
We identified 3790 hospitalized patients with COVID-19 testing across 19 hospitals, 102 of whom had positive test results. The median age was lower in the COVID-positive patients (62 vs 67 years; P=.03). The median duration of hospitalization was longer in COVID-positive patients (8.5 vs 4 days; P<.001) and more required intensive care unit care (56.9% [58 of 102] vs 26.8% [987 of 3688]; P<.001). Comorbidities, including atrial fibrillation/flutter, heart failure, chronic kidney disease, and malignancy, were observed less frequently with COVID-positive admissions. Any venous thromboembolism was identified in 2.9% of COVID-positive patients (3 of 102) and 4.6% of COVID-negative patients (168 of 3688). The frequency of venous and arterial events was not different between the groups. The unadjusted odds ratio (OR) for COVID-positive-patients for any venous thromboembolism was 0.63 (95% CI, 0.19 to 2.02). A multivariable logistic regression model evaluated death within 30 days of hospital discharge; neither COVID positivity (adjusted OR, 1.12; 95% CI, 0.54 to 2.34) nor thromboembolism (adjusted OR, 0.90; 95% CI, 0.60 to 1.32) was associated with death.
Conclusion:
Early experience in patients with COVID-19 across multiple academic and regional hospitals representing different US regions demonstrates a lower than previously reported incidence of thrombotic events. This incidence was not higher than a contemporary COVID-negative hospitalized comparator.