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Thrombosis of Medium-Sized and Large Arteries During Covid-19 Infection: Results of the COVIVASC Study
Raphael Coscas1, Maxime Dubosq1, Johanna Charton1
1Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, 92104 Boulogne-Billancourt, France; UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, 94807 Villejuif, France.
Insights
COVID-19 infection can cause rare but serious arterial thromboses (COV-ATs), primarily affecting the aorta and limb arteries. These complications are associated with high morbidity and mortality, necessitating further research into preventative anticoagulation strategies.
Area of Science:
- Vascular Medicine
- Infectious Diseases
- Cardiology
Background:
- COVID-19 infection is linked to both venous and arterial thromboses, stemming from endothelial dysfunction, coagulopathy, and rhythm disorders.
- The precise incidence, anatomical distribution, and prognosis of COVID-19-associated arterial thromboses (COV-ATs) require further elucidation.
Purpose of the Study:
- To document the experience with COV-ATs within the Greater Paris University Hospitals network during the initial wave of the COVID-19 pandemic.
- To analyze the incidence, affected sites, and outcomes of COV-ATs in hospitalized COVID-19 patients.
Main Methods:
- A retrospective study of hospitalized patients between March and May 2020 was conducted using the AP-HP clinical data warehouse.
- Patients with positive COVID-19 PCR tests and documented acute arterial thromboses (excluding coronary and intracranial arteries) were identified using French medical classification codes.
- Data on patient demographics, COV-AT characteristics, treatment, and outcomes were collected and analyzed.
Main Results:
- An incidence of 0.2% for COV-ATs was observed in 60 patients (mean age 71±14 years, 42% male) during the study period.
- The aorta and lower limb arteries were the most frequently affected sites (58% and 17% respectively), with complications occurring a median of 3 days post-infection.
- The study reported a high in-hospital or 30-day mortality rate of 30%, with 22% experiencing multiple thromboses and 15% suffering severe non-lethal ischemic complications.
Conclusions:
- Arterial involvement, particularly in the aorta and limb arteries, is an infrequent but serious complication of COVID-19 infection.
- Patients experiencing COV-ATs face significant morbidity and mortality.
- Further research is needed to determine if routine anticoagulation therapy can mitigate the incidence and severity of COV-ATs.
Background:
COVID-19 infection is associated not only with venous thromboses but also with arterial thromboses (COV-ATs) in relation with an endothelial dysfunction, a coagulopathy and rhythm disorders. The incidence, the topography, and the prognosis of COV-ATs remain poorly known. The objective of this study was to report the overall experience of the Greater Paris University Hospitals (Assistance Publique - Hopitaux de Paris, AP-HP) during the first pandemic wave of COVID-19 infection.
Methods:
After approval by the ethics committee, a study using the AP-HP clinical data warehouse was carried out between March and May 2020. Overall, 124,609 patients had a polymerase chain reaction for COVID-19 in our hospitals, of which 25,345 were positive. From 20,710 exploitable stays, patients tested positive for COVID who presented an episode of acute COV-AT (except coronary and intracranial arteries) were selected on the basis of the French medical classification for clinical procedures codes. The data are presented as absolute values with percentages and/or means with standard deviation.
Results:
Over the studied period, 60 patients (aged 71±14 years, 42 men) presented a COV-AT at the time of their hospitalization, an incidence of 0.2%. The arterial complication occurred 3±7 days after the COVID infection and was inaugural in 30% of the cases (n = 18). The sites of COV-AT were the lower extremities (n = 35%, 58%), the abdominal aorta (n = 10%, 17%), the thoracic aorta (n = 7%, 12%), the upper limbs (n = 7%, 12%), the cerebral arteries (n = 7%, 12%), the digestive arteries (n = 6%, 10%), the renal arteries (n = 2%, 3%), and the ophthalmic artery (n = 1%, 2%). Multiple COV-ATs were observed in 13 patients (22%). At the time of diagnosis, 20 (33%) patients were in intensive care, including six (10%) patients who were intubated. On computed tomography angiography, COVID lesions were classified as moderate and severe in 25 (42%) and 21 (35%) cases, respectively. Revascularization was attempted in 27 patients (45%), by open surgery in 16 cases, using endovascular techniques in 8 cases and with a hybrid approach in three cases. Six patients (22%) required reinterventions. The duration of hospitalization was 12±9 days. Early mortality (in-hospital or at 30 days) was 30% (n = 18). Nine (15%) patients presented severe nonlethal ischemic complications.
Conclusions:
Arterial involvement is rare during COVID-19 infection. The aorta and the arteries of the limbs are the privileged sites. The morbi-mortality of these patients is high. Future studies will have to determine if the systematization of anticoagulation therapy decreases the incidence and the severity of the condition.
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