Thromboembolism, CV Complications Common in Hospitalized COVID-19 Patients

Patients with COVID-19 have a high frequency of major arterial or venous thromboembolism, major adverse cardiovascular events and symptomatic venous thromboembolism, despite routine thromboprophylaxis, according to a study published Oct. 26 in the Journal of the American College of Cardiology.

Gregory Piazza, MD, MS, FACC, et al., abstracted data from the electronic health records (EHRs) of the Mass General Brigham integrated health network. Researchers identified 1,114 patients age 18 years or older who tested positive for COVID-19 from March 13 to April 3, 2020.

Of the total cohort, 170 were treated in the intensive care unit (ICU); 229 in non-ICU settings; and 715 in an outpatient clinic. The results show 22.3% of patients were Hispanic/Latinx and 44.2% were nonwhite. Common cardiovascular risk factors included hypertension (35.8%), hyperlipidemia (28.6%) and diabetes (18%).

Among hospitalized patients, 89.4% in the ICU and 84.7% in non-ICU settings received prophylactic anticoagulation. Patients in the ICU were most likely to experience the primary outcome of major arterial or venous thromboembolism (35.3%), major cardiovascular adverse events (45.9%) and symptomatic venous thromboembolism (27%). Among patients hospitalized in non-ICU care, 2.6% experienced the primary outcome of major arterial or venous thromboembolism, while major cardiovascular adverse events and symptomatic venous thromboembolism occurred in 6.1%, and 2.2%, respectively. These outcomes did not occur in those treated as outpatients.

According to the researchers, arterial or venous thromboembolism and major adverse cardiovascular events are common among ICU patients with COVID-19. They note that COVID-19 patients hospitalized in non-ICU settings are also susceptible to cardiovascular complications. The high rates of thromboembolism despite prophylaxis "suggests the need for improved risk stratification and enhanced preventive efforts," they conclude.

The study "adds important information to the growing number of publications of COVID-19–associated thromboembolism," writes Robert D. McBane II, MD, FACC, in an accompanying editorial comment. "Whether to interpret these results as alarming or reassuring requires a comparison of expected thromboembolic event rates separate from the pandemic," he writes, adding that aside from central line-associated venous thrombosis, the rates "are similar to expected rates for patients hospitalized without COVID-19."

Clinical Topics: Anticoagulation Management, Dyslipidemia, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine, Anticoagulation Management and Venothromboembolism, Hypertension

Keywords: Venous Thromboembolism, COVID-19, Pandemics, Anticoagulants, Hyperlipidemias, Outpatients, Electronic Health Records, Cardiovascular Diseases, Risk Factors, severe acute respiratory syndrome coronavirus 2, Venous Thrombosis, Diabetes Mellitus, Hypertension, Intensive Care Units


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