Low absolute risk of thrombotic and cardiovascular events in outpatient pregnant women with COVID-19.

Autor: Bikdeli B; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA; YNHH/ Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA; Cardiovascular Research Foundation (CRF), New York, NY, USA., Krishnathasan D; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA., Khairani CD; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA., Bejjani A; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA., Davies J; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA., Porio N; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA., Tristani A; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA., Armero A; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA., Assi AA; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Nauffal V; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA., Campia U; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA., Almarzooq Z; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA., Wei E; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA., Ortiz-Rios MD; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Zuluaga-Sánchez V; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA., Achanta A; Department of Medicine, Massachusetts General Hospital, Boston, MA, USA., Jesudasen SJ; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA., Tiu B; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA., Merli GJ; Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA., Leiva O; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Fanikos J; Department of Pharmacy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Grandone E; Thrombosis and Haemostasis Unit, Fondazione I.R.C.C.S. 'Casa Sollievo della Sofferenza', S. Giovanni Rotondo (Foggia), Italy; Department of Obstetrics and Gynecology, First I.M. Sechenov Moscow State Medical University, Moscow, Russia., Sharma A; Department of Medicine, Cardiovascular Medicine, University of Virginia Health, Charlottesville, VA, USA., Rizzo S; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA., Pfeferman MB; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA., Morrison RB; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA., Vishnevsky A; Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA., Hsia J; CPC Clinical Research, Aurora, CO, USA; Department of Medicine, University of Colorado, Aurora, CO, USA., Nehler MR; CPC Clinical Research, Aurora, CO, USA., Welker J; Anne Arundel Research Institute, Annapolis, MD, USA., Bonaca MP; CPC Clinical Research, Aurora, CO, USA; Department of Medicine, University of Colorado, Aurora, CO, USA., Carroll B; Smith Center for Cardiovascular Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA., Goldhaber SZ; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA., Lan Z; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA; Center for Clinical Investigation, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Piazza G; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, USA; Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, USA. Electronic address: gpiazza@bwh.harvard.edu.
Jazyk: angličtina
Zdroj: Thrombosis research [Thromb Res] 2024 May; Vol. 237, pp. 209-215. Date of Electronic Publication: 2024 Apr 06.
DOI: 10.1016/j.thromres.2024.02.021
Abstrakt: Introduction: Pregnancy may contribute to an excess risk of thrombotic or cardiovascular events. COVID-19 increases the risk of these events, although the risk is relatively limited among outpatients. We sought to determine whether outpatient pregnant women with COVID-19 are at a high risk for cardiovascular or thrombotic events.
Materials & Methods: We analyzed pregnant outpatients with COVID-19 from the multicenter CORONA-VTE-Network registry. The main study outcomes were a composite of adjudicated venous or arterial thrombotic events, and a composite of adjudicated cardiovascular events. Events were assessed 90 days after the COVID-19 diagnosis and reported for non-pregnant women ≤45 years, and for men ≤45 years, as points of reference.
Results: Among 6585 outpatients, 169 were pregnant at diagnosis. By 90-day follow-up, two pregnant women during the third trimester had lower extremity venous thrombosis, one deep and one superficial vein thrombosis. The cumulative incidence of thrombotic events was 1.20 % (95 % confidence interval [CI]: 0.0 to 2.84 %). Respective rates were 0.47 % (95 % CI: 0.14 % to 0.79 %) among non-pregnant women, and 0.49 % (95 % CI: 0.06 % to 0.91 %) among men ≤45 years. No non-thrombotic cardiovascular events occurred in pregnant women. The rates of cardiovascular events were 0.53 % (95 % CI: 0.18 to 0.87) among non-pregnant women, and 0.68 % (95 % CI: 0.18 to 1.18) in men aged ≤45 years.
Conclusions: Thrombotic and cardiovascular events are rare among outpatients with COVID-19. Although a higher event rate among outpatient pregnant women cannot be excluded, the absolute event rates are low and do not warrant population-wide cardiovascular interventions to optimize outcomes.
Competing Interests: Declaration of competing interest Dr. Bikdeli is supported by a Career Development Award from the American Heart Association and VIVA Physicians (#938814). Dr. Bikdeli was supported by the Scott Schoen and Nancy Adams IGNITE Award and is supported by the Mary Ann Tynan Research Scientist award from the Mary Horrigan Connors Center for Women's Health and Gender Biology at Brigham and Women's Hospital to conduct sex-informed analyses of cardiovascular diseases, and the Heart and Vascular Center Junior Faculty Award from Brigham and Women's Hospital to understand the epidemiology and therapeutics for COVID-19-assocaited thrombosis. Dr. Bikdeli reports that he is a consulting expert, on behalf of the plaintiff, for litigation related to two specific brand models of IVC filters (no involvement or financial compensation in 2022 or 2023), is a member of the Medical Advisory Board for North American Thrombosis Forum, and serves in the Data Safety and Monitory Board of the NAIL-IT trial funded by the National Heart, Lung, and Blood Institute, and Translational Sciences. Dr. Grandone has received consulting fees from Kedrion, Novo-Nordisk, Werfen, Techdow Pharma, Rovi and CSL-Behring. Drs. Bonaca, Hsia and Nehler receive salary support from CPC, a non-profit academic research organization affiliated with the University of Colorado, that receives or has received research grant/consulting funding between February 2021 and February 2023 from the following organizations: Abbott Laboratories, Adamis Pharmaceuticals Corporation, Agios Pharmaceuticals, Inc., Alexion Pharma, Alnylam Pharmaceuticals, Inc., Amgen Inc., Angionetics, Inc., ARCA Biopharma, Inc., Array BioPharma, Inc., AstraZeneca and Affiliates, Atentiv LLC, Audentes Therapeutics, Inc., Bayer and Affiliates, Beth Israel Deaconess Medical Center, Better Therapeutics, Inc., BIDMC, Boston Clinical Research Institute, Bristol-Meyers Squibb Company, Cambrian Biopharma, Inc., Cardiol Therapeutics Inc., CellResearch Corp., Cleerly Health, Cook Medical Incorporated, Covance, CSL Behring LLC, Eidos Therapeutics, Inc., EP Trading Co. Ltd., EPG Communication Holdings Ltd., Epizon Pharma, Inc., Esperion Therapeutics, Inc., Everly Well, Inc., Exicon Consulting Pvt. Ltd., Faraday Pharmaceuticals, Inc., Foresee Pharmaceuticals Co. Ltd., Fortress Biotech, Inc., HDL Therapeutics Inc., HeartFlow Inc., Hummingbird Bioscience, Insmed Inc., Ionis Pharmaceuticals, IQVIA Inc., JanOne Biotech Holdings Inc., Janssen and Affiliates, Kaneka, Kowa Research Institute, Inc., Kyushu University, Lexicon Pharmaceuticals, Inc., LSG Kyushu University, Medimmune Ltd., Medpace, Merck & Affiliates, Novartis Pharmaceuticals Corp., Novate Medical, Ltd., Novo Nordisk, Inc., Pan Industry Group, Pfizer Inc., PhaseBio Pharmaceuticals, Inc., PPD Development, LP, Prairie Education and Research Cooperative, Prothena Biosciences Limited, Regeneron Pharmaceuticals, Inc., Regio Biosciences, Inc., Rexgenero, Sanifit Therapeutics S.A., Sanofi-Aventis Groupe, Silence Therapeutics PLC, Smith & Nephew plc, Stealth BioTherapeutics Inc., State of Colorado CCPD Grant, The Brigham & Women's Hospital, Inc., The Feinstein Institutes for Medical Research, Thrombosis Research Institute, University of Colorado, University of Pittsburgh, VarmX, Virta Health Corporation, WCT Atlas, Worldwide Clinical Trials Inc., WraSer, LLC, and Yale Cardiovascular Research Group. Dr. Hsia also reports owning AstraZeneca stock. Dr. Bonaca receives support from the AHA SFRN under award numbers 18SFRN3390085 (BWH-DH SFRN Center) and 18SFRN33960262 (BWH-DH Clinical Project). Dr. Bonaca also reports stock in Medtronic and Pfizer. Dr. Sharma reports that he receives institutional grant funding from Boston Scientific Corporation and Vascular Medcure, is a board member for the Society for Vascular Medicine, and receives Speaking honoraria from Boston Scientific Corporation. Dr. Goldhaber reports research support from Bayer, BMS, Boston Scientific BTG EKOS, Janssen, NHLBI, and Pfizer, and consulting fees from Pfizer. Dr. Piazza has received research support from Bristol-Myers Squibb/Pfizer Alliance, Bayer, Janssen, Alexion, Amgen and Boston Scientific Corporation, and consulting fees from Bristol-Myers Squibb/Pfizer Alliance, Boston Scientific Corporation, Janssen, NAMSA, Penumbra, Prairie Education and Research Cooperative, Boston Clinical Research Institute, and Amgen. The remaining authors have no Disclosures to report.
(Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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