Association of COVID-19 With Major Arterial and Venous Thrombotic Diseases: A Population-Wide Cohort Study of 48 Million Adults in England and Wales-Reference-Cited by-同舟云学术

Association of COVID-19 With Major Arterial and Venous Thrombotic Diseases: A Population-Wide Cohort Study of 48 Million Adults in England and Wales

Published:2022-09-20 Issue:12 Volume:146 Page:892-906
ISSN:0009-7322
Container-title:Circulation
language:en
Short-container-title:Circulation

Author:

Knight Rochelle¹²³⁴^ORCID,Walker Venexia¹⁴^ORCID,Ip Samantha⁵⁶,Cooper Jennifer A.¹²,Bolton Thomas⁵⁷⁸,Keene Spencer⁵⁷^ORCID,Denholm Rachel¹²⁹^ORCID,Akbari Ashley¹⁰^ORCID,Abbasizanjani Hoda¹⁰^ORCID,Torabi Fatemeh¹⁰^ORCID,Omigie Efosa¹¹,Hollings Sam¹¹^ORCID,North Teri-Louise¹,Toms Renin¹¹²^ORCID,Jiang Xiyun⁵^ORCID,Angelantonio Emanuele Di⁵⁷¹³¹⁴^ORCID,Denaxas Spiros¹⁵¹⁶¹⁷¹⁸,Thygesen Johan H.¹⁶^ORCID,Tomlinson Christopher¹⁶¹⁹¹⁷^ORCID,Bray Ben²⁰,Smith Craig J.²¹²²,Barber Mark²³^ORCID,Khunti Kamlesh²⁴,Davey Smith George¹⁴^ORCID,Chaturvedi Nishi²⁵^ORCID,Sudlow Cathie⁸^ORCID,Whiteley William N.²⁶²⁷^ORCID,Wood Angela M.⁵⁷¹³¹⁴²⁸,Sterne Jonathan A.C.¹²⁹^ORCID,

Affiliation:

1. Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.).

2. NIHR Bristol Biomedical Research Centre, UK (R.K., J.A.C., R.D., J.A.C.S.).

3. NIHR Applied Research Collaboration West, Bristol, UK (R.K.).

4. MRC Integrative Epidemiology Unit, Bristol, UK (R.K., V.W., G.D.S.).

5. British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK.

6. Centre for Cancer Genetic Epidemiology (S.I.), University of Cambridge, UK.

7. Department of Public Health and Primary Care, NIHR Blood and Transplant Research Unit in Donor Health and Genomics (T.B., S.K., E.D.A., A.M.W.), University of Cambridge, UK.

8. British Heart Foundation Data Science Centre (T.B., C.S.), London.

9. Health Data Research UK South-West, Bristol (R.D., J.A.C.S.).

10. Population Data Science, Swansea University Medical School, Swansea University, Wales, UK (A.A., H.A., F.T.).

11. National Health Service Digital, Leeds, UK (E.O., S.H.).

12. School of Health Sciences, Cardiff Metropolitan University, UK (R.T.).

13. British Heart Foundation Centre of Research Excellence (E.D.A., A.M.W.), University of Cambridge, UK.

14. Wellcome Genome Campus, Health Data Research UK Cambridge (E.D.A., A.M.W.).

15. Health Data Research UK (S.D.), London.

16. Institute of Health Informatics (S.D., J.H.T., C.T.), University College London, UK.

17. University College London Hospitals Biomedical Research Centre (C.T., S.D.), University College London, UK.

18. BHF Accelerator, London, UK (S.D.).

19. UK Research and Innovation Centre for Doctoral Training in AI-Enabled Healthcare Systems (C.T.), University College London, UK.

20. School of Population Health and Environmental Sciences, King’s College London, UK (B.B.).

21. Geoffrey Jefferson Brain Research Centre, Manchester Centre for Clinical Neurosciences, Northern Care Alliance National Health Service Foundation Trust, Salford Royal Hospital, UK (C.J.S.).

22. Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, University of Manchester, UK (C.J.S.).

23. Glasgow Caledonian University, UK (M.B.).

24. Diabetes Research Centre, University of Leicester, UK (K.K.).

25. MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science (N.C.), University College London, UK.

26. Centre for Clinical Brain Sciences, University of Edinburgh, UK (W.N.W.).

27. Nuffield Department of Population Health, University of Oxford, UK (W.N.W.).

28. NIHR Cambridge Biomedical Research Centre, UK (A.M.W.).

Abstract

Background: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces a prothrombotic state, but long-term effects of COVID-19 on incidence of vascular diseases are unclear. Methods: We studied vascular diseases after COVID-19 diagnosis in population-wide anonymized linked English and Welsh electronic health records from January 1 to December 7, 2020. We estimated adjusted hazard ratios comparing the incidence of arterial thromboses and venous thromboembolic events (VTEs) after diagnosis of COVID-19 with the incidence in people without a COVID-19 diagnosis. We conducted subgroup analyses by COVID-19 severity, demographic characteristics, and previous history. Results: Among 48 million adults, 125 985 were hospitalized and 1 319 789 were not hospitalized within 28 days of COVID-19 diagnosis. In England, there were 260 279 first arterial thromboses and 59 421 first VTEs during 41.6 million person-years of follow-up. Adjusted hazard ratios for first arterial thrombosis after COVID-19 diagnosis compared with no COVID-19 diagnosis declined from 21.7 (95% CI, 21.0–22.4) in week 1 after COVID-19 diagnosis to 1.34 (95% CI, 1.21–1.48) during weeks 27 to 49. Adjusted hazard ratios for first VTE after COVID-19 diagnosis declined from 33.2 (95% CI, 31.3–35.2) in week 1 to 1.80 (95% CI, 1.50–2.17) during weeks 27 to 49. Adjusted hazard ratios were higher, for longer after diagnosis, after hospitalized versus nonhospitalized COVID-19, among Black or Asian versus White people, and among people without versus with a previous event. The estimated whole-population increases in risk of arterial thromboses and VTEs 49 weeks after COVID-19 diagnosis were 0.5% and 0.25%, respectively, corresponding to 7200 and 3500 additional events, respectively, after 1.4 million COVID-19 diagnoses. Conclusions: High relative incidence of vascular events soon after COVID-19 diagnosis declines more rapidly for arterial thromboses than VTEs. However, incidence remains elevated up to 49 weeks after COVID-19 diagnosis. These results support policies to prevent severe COVID-19 by means of COVID-19 vaccines, early review after discharge, risk factor control, and use of secondary preventive agents in high-risk patients.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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