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Published on: July 18, 2014
COVID-19-Related Thrombotic and Bleeding Events in Adults With Congenital Heart Disease
Flavia Fusco1, Richard A Krasuski2, Soraya Sadeghi3
1Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples, Italy.
Insights
Adult patients with congenital heart disease (ACHD) experiencing COVID-19 have a higher risk of thromboembolic (TE) and bleeding complications, leading to increased mortality. Severe COVID-19, cardiac injury, and prior anticoagulation are key risk factors.
Area of Science:
- Cardiology
- Infectious Diseases
- Hematology
Background:
- Altered coagulation is a significant concern in COVID-19 patients.
- Adult patients with congenital heart disease (ACHD) are susceptible to both thromboembolic (TE) and bleeding events.
Purpose of the Study:
- To determine the incidence and identify risk factors for TE/bleeding complications in ACHD patients diagnosed with COVID-19.
Main Methods:
- A cohort of COVID-19-positive ACHD patients was analyzed from May 2020 to November 2021.
- TE events, major bleeding, and severe infection were defined. Logistic regression identified associated factors.
Main Results:
- 1.5% of 1,988 ACHD patients experienced TE/bleeding complications.
- These patients had significantly higher in-hospital mortality (33% vs 1.7%) and poorer baseline health indicators.
- Independent risk factors for TE/bleeding included prior anticoagulation, cardiac injury, and severe COVID-19 infection.
Conclusions:
- TE/bleeding complications in ACHD patients with COVID-19 are associated with increased in-hospital mortality.
- Severe COVID-19, cardiac injury during infection, and anticoagulant use are significant risk factors for these complications.
Background:
Altered coagulation is a striking feature of COVID-19. Adult patients with congenital heart disease (ACHD) are prone to thromboembolic (TE) and bleeding complications.
Objectives:
The purpose of this study was to investigate the prevalence and risk factors for COVID-19 TE/bleeding complications in ACHD patients.
Methods:
COVID-19-positive ACHD patients were included between May 2020 and November 2021. TE events included ischemic cerebrovascular accident, systemic and pulmonary embolism, deep venous thrombosis, myocardial infarction, and intracardiac thrombosis. Major bleeding included cases with hemoglobin drop >2 g/dl, involvement of critical sites, or fatal bleeding. Severe infection was defined as need for intensive care unit, endotracheal intubation, renal replacement therapy, extracorporeal membrane oxygenation, or death. Patients with TE/bleeding were compared to those without events. Factors associated with TE/bleeding were determined using logistic regression.
Results:
Of 1,988 patients (age 32 [IQR: 25-42] years, 47% male, 59 ACHD centers), 30 (1.5%) had significant TE/bleeding: 12 TE events, 12 major bleeds, and 6 with both TE and bleeding. Patients with TE/bleeding had higher in-hospital mortality compared to the remainder cohort (33% vs 1.7%; P < 0.0001) and were in more advanced physiological stage (P = 0.032) and NYHA functional class (P = 0.01), had lower baseline oxygen saturation (P = 0.0001), and more frequently had a history of atrial arrhythmia (P < 0.0001), previous hospitalization for heart failure (P < 0.0007), and were more likely hospitalized for COVID-19 (P < 0.0001). By multivariable logistic regression, prior anticoagulation (OR: 4.92; 95% CI: 2-11.76; P = 0.0003), cardiac injury (OR: 5.34; 95% CI: 1.98-14.76; P = 0.0009), and severe COVID-19 (OR: 17.39; 95% CI: 6.67-45.32; P < 0.0001) were independently associated with increased risk of TE/bleeding complications.
Conclusions:
ACHD patients with TE/bleeding during COVID-19 infection have a higher in-hospital mortality from the illness. Risk of coagulation disorders is related to severe COVID-19, cardiac injury during infection, and use of anticoagulants.
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