Postdischarge thromboembolic outcomes and mortality of hospitalized patients with COVID-19: the CORE-19 registry
Author:
Giannis Dimitrios12ORCID, Allen Steven L.34, Tsang James1, Flint Sarah14, Pinhasov Tamir14, Williams Stephanie14, Tan Gary14ORCID, Thakur Richa14ORCID, Leung Christian14ORCID, Snyder Matthew14, Bhatia Chirag14ORCID, Garrett David14, Cotte Christina14, Isaacs Shelby14, Gugerty Emma14ORCID, Davidson Anne56, Marder Galina S.5, Schnitzer Austin5, Goldberg Bradley34, McGinn Thomas14, Davidson Karina W.14ORCID, Barish Matthew A.7ORCID, Qiu Michael1, Zhang Meng1, Goldin Mark14, Matsagkas Miltiadis2, Arnaoutoglou Eleni8, Spyropoulos Alex C.14ORCID
Affiliation:
1. Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY; 2. Department of Vascular Surgery, University of Thessaly, Larissa, Greece; 3. Division of Hematology, 4. Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; 5. Division of Rheumatology, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; 6. Institute of Molecular Medicine, Feinstein Institutes for Medical Research, and 7. Department of Radiology, Northwell Health, Manhasset, NY; and 8. Department of Anesthesiology, University of Thessaly, Larissa, Greece
Abstract
Abstract
Thromboembolic events, including venous thromboembolism (VTE) and arterial thromboembolism (ATE), and mortality from subclinical thrombotic events occur frequently in coronavirus disease 2019 (COVID-19) inpatients. Whether the risk extends postdischarge has been controversial. Our prospective registry included consecutive patients with COVID-19 hospitalized within our multihospital system from 1 March to 31 May 2020. We captured demographics, comorbidities, laboratory parameters, medications, postdischarge thromboprophylaxis, and 90-day outcomes. Data from electronic health records, health informatics exchange, radiology database, and telephonic follow-up were merged. Primary outcome was a composite of adjudicated VTE, ATE, and all-cause mortality (ACM). Principal safety outcome was major bleeding (MB). Among 4906 patients (53.7% male), mean age was 61.7 years. Comorbidities included hypertension (38.6%), diabetes (25.1%), obesity (18.9%), and cancer history (13.1%). Postdischarge thromboprophylaxis was prescribed in 13.2%. VTE rate was 1.55%; ATE, 1.71%; ΑCM, 4.83%; and MB, 1.73%. Composite primary outcome rate was 7.13% and significantly associated with advanced age (odds ratio [OR], 3.66; 95% CI, 2.84-4.71), prior VTE (OR, 2.99; 95% CI, 2.00-4.47), intensive care unit (ICU) stay (OR, 2.22; 95% CI, 1.78-2.93), chronic kidney disease (CKD; OR, 2.10; 95% CI, 1.47-3.0), peripheral arterial disease (OR, 2.04; 95% CI, 1.10-3.80), carotid occlusive disease (OR, 2.02; 95% CI, 1.30-3.14), IMPROVE-DD VTE score ≥4 (OR, 1.51; 95% CI, 1.06-2.14), and coronary artery disease (OR, 1.50; 95% CI, 1.04-2.17). Postdischarge anticoagulation was significantly associated with reduction in primary outcome (OR, 0.54; 95% CI, 0.47-0.81). Postdischarge VTE, ATE, and ACM occurred frequently after COVID-19 hospitalization. Advanced age, cardiovascular risk factors, CKD, IMPROVE-DD VTE score ≥4, and ICU stay increased risk. Postdischarge anticoagulation reduced risk by 46%.
Publisher
American Society of Hematology
Subject
Cell Biology,Hematology,Immunology,Biochemistry
Cited by
133 articles.
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