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Published on: December 19, 2020
Incidence and characteristics of arterial thromboemboli in patients with COVID-19
Nancy Glober1, Lauren Stewart1, JangDong Seo1
1Indiana University, Indianapolis, Indiana, United States.
Insights
COVID-19 infection was linked to fewer arterial thromboemboli overall, but increased risk in extremities. Metabolic syndrome predicted clot formation in COVID-19 patients.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Epidemiology
Background:
- Studies indicate COVID-19 is an independent risk factor for arterial thromboemboli.
- Arterial thromboemboli, including myocardial infarction, ischemic stroke, and peripheral artery events, are serious complications.
Purpose of the Study:
- To determine the incidence and location of arterial thromboemboli in patients with and without COVID-19.
- To investigate the association of comorbidities with arterial thromboemboli in the context of COVID-19 infection.
Main Methods:
- Cross-sectional analysis of the RECOVER database (45 US medical centers).
- Data collected on 26,974 patients, stratified by COVID-19 status.
- Chi-squared tests used to analyze associations between comorbidities, COVID-19 status, and arterial thromboemboli.
Main Results:
- Arterial thromboemboli incidence was 0.13% in COVID-19 positive and 0.19% in COVID-19 negative patients.
- Arterial thromboemboli were more common in extremities than core organs in COVID-19 patients (OR 2.04).
- Metabolic syndrome predicted core (p=0.001) and extremity (p=0.010) arterial thrombus in COVID-19 patients. Statin use was associated with lower thrombus risk (p=0.014).
Conclusions:
- Arterial thromboemboli were less common in patients with COVID-19 than in those without.
- Metabolic syndrome may be associated with arterial clot formation in COVID-19 patients.
Background:
Studies have reported COVID-19 as an independent risk factor for arterial thromboemboli.
Methods:
From a cross-sectional sample, we determined the incidence and location of arterial thromboemboli (myocardial infarction, ischemic stroke, peripheral artery), stratified by COVID-19 status, in the RECOVER database, which included data on patients at 45 United States medical centers in 22 states. Epidemiological factors, clinical characteristics and outcomes were collected through a combination of individual chart review and automatic electronic query and recorded in REDCap®. We investigated the association of baseline comorbidities on the development of arterial thromboemboli and analyzed results based on the presence or absence of concomitant COVID-19 infection, testing this association with Chi-squared. We also described use of anticoagulants and statins.
Results:
Data were collected on 26,974 patients, of which 13,803 (51.17%) tested positive for COVID-19. Incidence of arterial thromboemboli during hospitalization was 0.13% in patients who tested positive for COVID-19 and 0.19% in patients who tested negative. Arterial thromboemboli tended to be more common in extremities than in core organs (heart, kidney, lung, liver) in patients with COVID-19, odds ratio 2.04 (95% CI 0.707 - 5.85). Patients with COVID-19 were less likely to develop an arterial thrombus when on baseline statin medication (p=0.014). Presence of metabolic syndrome predicted presence of core arterial thrombus (p=0.001) and extremity arterial thrombus (p=0.010) in those with COVID-19. Arterial thromboemboli were less common in patients with COVID-19 than in those who tested negative for COVID-19.
Conclusions:
Presence of a composite metabolic syndrome profile may be associated with arterial clot formation in patients with COVID-19 infection.
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