Postdischarge thromboembolic outcomes and mortality of hospitalized patients with COVID-19: the CORE-19 registry
| Autor: | Eleni Arnaoutoglou, Richa Thakur, Anne Davidson, Thomas McGinn, Matthew A. Barish, Mark Goldin, Bradley Goldberg, Alex C. Spyropoulos, Galina Marder, James Tsang, Steven L. Allen, Michael Qiu, Dimitrios Giannis, Chirag Bhatia, Shelby Isaacs, Christian Leung, Sarah Flint, Tamir Pinhasov, Emma Gugerty, Matthew Snyder, Meng Zhang, Austin Schnitzer, Stephanie Williams, Karina W. Davidson, David Garrett, Christina Cotte, Gary Tan, Miltiadis Matsagkas |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Immunology 030204 cardiovascular system & hematology Biochemistry law.invention Coronary artery disease 03 medical and health sciences 0302 clinical medicine law Risk Factors Internal medicine Diabetes mellitus Thromboembolism medicine Humans 030212 general & internal medicine Registries Subclinical infection Aged business.industry SARS-CoV-2 Anticoagulants COVID-19 Regular Article Cell Biology Hematology Odds ratio Middle Aged medicine.disease Comorbidity Obesity Intensive care unit Patient Discharge Female business Kidney disease |
| Zdroj: | Blood |
| ISSN: | 1528-0020 |
| Popis: | 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%. |
| Databáze: | OpenAIRE |
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